Preamble

The House met at half-past Nine o'clock

PRAYERS

[MR. SPEAKER in the Chair]

Women's Health

Motion made, and Question proposed, That this House do now adjourn.—[Mr. Peter Lloyd.]

The Parliamentary Under-Secretary of State for Health and Social Security (Mrs. Edwina Currie): This is, I believe, the first debate on women's health called in Government time for a long while, and I believe that it shows how far we have come on this important topic. In a moment I shall outline some of the major improvements that we have seen in the last year or so, and some aspects on which I want to take matters forward.
Women have been receiving advice on their health and welfare for a long time. Here is the columnist of Home Companion magazine of 12 November 1898, writing in answer to two correspondents:
In your trouble, 'AM', you have my sympathy, and though I can hardly tell you how to become as thin and wan as a willow, I can at least tell you how you can reduce your form to graceful proportions. Take plenty of vigorous exercise and I advise you especially to try bicycling … And here comes 'Dorothy' who wants to know how she can grow stout. Laugh, and grow fat, 'Dorothy'. A good laugh promotes digestion and tends to lengthen life. All good advice!
Modern problems have also been around for a long time. This is "Meg", writing to Woman's Weekly in June 1918—the date is significant:
I should very much like to have your opinion on the modern woman's craze for smoking. One hears so much for and against the habit. A few years ago when I was in Paris, I asked a Frenchman if he admired a woman who smoked. He replied: 'Well, I should not like my wife to smoke, and would not allow her to.
The answer would not satisfy us today:
I don't approve of men taking this kind of tone, as if their wives were small children; but at the same time, I think Meg's words are worth attention from another point of view. Tobacco is getting very short and we are told it will have to be rationed. Think of what that will mean to our soldiers and sailors. Girls, every packet of cigarettes you buy to smoke yourselves leaves a packet less for our fighting men!
But yesterday's agony aunts had a different attitude on other subjects. Here is one letter, coyly signed "Wavelet", on the problems of cycling, in Home Chat magazine of April 1897:
On a recent cycle ride, I was overtaken by another cyclist who told me one of my tyres was soft, and offered to blow it up for me. I accepted his offer. Since then, when we meet, he bows. Yesterday, I had a note asking me to take a ride with him on Sunday week. He appears to be a gentleman, but I don't know what to do with regard to this request.
The answer was very firm:
Give the letter to your parents, who will no doubt so deal with it that this very impertinent young man will not take such a liberty again.
The obvious question to ask is why women's health? Why not health in general? Is it not somewhat artificial to separate out "women's health", along with "women's

issues", "women's rights" and other, as Private Eye would put it, "loony feminist nonsense"? I am no feminist. When I was asked to take on responsibility for women's health in 1986 I wondered whether, apart from maternity, there were indeed any separate issues. There are two answers: we should look at women's health because it is completely different from men's health at almost every stage in our lives, and because many aspects of women's health and women's role in the health of their families have perhaps received far less attention in the past then they merited, not just from men but also from the women.
The differences start from the first day. More boy babies are born, but relatively more girls survive: we do not know why. Women outnumber men in every age group after middle age and the imbalance slowly increases throughout later life, until women form two thirds of the age group above 75. Thus, illnesses that increase with age affect far more women than men, and women account for the majority of in-patients in the National Health Service—that does not apply to acute care only. Women outnumber men in most age groups in diagnoses of mental illness in England; for every three men admitted to NHS mental illness hospitals and units in 1986 there were four women. Even if elderly people—75 and above—are excluded, the ratio is two men to three women. In fact, admission rates for women outnumber those for men in most of the main diagnostic groups in mental illness. The main exceptions are schizophrenia, and drug and alcohol-related mental illness—although for the latter two, women are beginning to catch up.
Women's health is different. Women tend to suffer from different ailments, and not just the obvious ones associated with reproduction. Among the preventable diseases, our main killer in this country is heart disease. It is mostly men, however, who die of heart disease. Women in middle age are on the whole far less affected than men by diseases of the cardiovascular system, unless, of course they are foolish enough to be smoking while on the pill, when their risk of a heart attack rises 10 times. In middle age, women are more likely to be victims of cancer, particularly breast cancer. It follows therefore, that health campaigns for women that may help to improve their chances of reaching a healthy and happy old age are significantly different from those for men.
Let us consider some issues of concern to women. The major killer of women before their time in the United Kingdom is breast cancer. About 250,000 women every year in the United Kingdom get a breast lump—90 per cent. are benign but 24,000 are cancer and 15,000 women die each year from this disease. That is more than seven times as many as from cervical cancer, which is probably the better known disease. The survival rate is improving. Sixty four per cent.—nearly two thirds—survive longer than five years now following first diagnosis of breast cancer, and there should be a real improvement in survival in the next decade. Although much research is under way, there is no clear causal link between breast cancer and environment or lifestyle. Therefore, apart from women with a family history of the disease, who can be warned to be especially vigilant, there is as yet no good advice we can give women on how to avoid it. That is one reason why we have developed the breast cancer screening programme. If we cannot avoid the disease—primary prevention—then the next best is to find it as early as possible and treat it while still curable—secondary prevention.
Many hon. Members will know that the NHS is setting up a national breast cancer screening service over the three years to 1990. The programme traces its origins to a working group that was set up in July 1985 on behalf of United Kingdom Health Ministers. The group was chaired by Professor Sir Patrick Forrest from Edinburgh. In February 1987, the then Secretary of State, my right hon. Friend the Member for Sutton Coldfield (Mr. Fowler), announced the Government's acceptance of the proposals in the Forrest group's report.
The Forrest report concluded that screening women aged 50 to 64 by mammography every three years should eventually reduce the deaths from breast cancer by at least one third. That is several thousand women. The NHS breast cancer screening service will do what he recommended, and provide a computerised call and recall system to screen women in the age group 50 to 64 by mammography with screening for women of 65 and over if requested.
We are often asked, why not younger women? As a younger woman I assure the House that, if there was any evidence that screening would help, that would have been taken in to account, but there is insufficient evidence to show that mass screening for younger women is effective in significantly reducing mortality, and more research is under way. Younger women at special risk—for example if there is a family history of breast cancer—may be offered mammography if referred by their general practitioner. Hon. Members may already know that 88 per cent. of all deaths from this cancer occur in the over-50s and its incidence in young women is far less common.
I am glad to report that the programme is making excellent progress. Each of the 14 English regional health authorities was asked to set up its first screening centre by the end of March 1988. In fact, 17 centres have now been set up—of which four will provide training for staff from the whole programme—and nearly all have now started screening. This afternoon, I shall he visiting the London training centre at King's college hospital and the first inner London screening unit at Camberwell.
By 1990, we expect to have about 100 centres nationwide, each covering a population of about half a million people. Mobile caravans will be used for screening in some areas. We hope to announce all the details about the remaining centres before the recess. The programme must be developed relatively slowly because of the need to train staff and to provide back-up facilities for diagnosis, treatment, counselling and after-care. The initial response has been excellent—in some places over 80 per cent. of the first women responded to their screening invitation. That is very encouraging.
Between 1987–88, the last financial year, and 1989–90, on current plans, nearly £55 million will have been provided to set up and run the screening centres including staff training, development of computer software, health education and counselling and support for patients. A service on the same lines is being developed in Scotland, Wales and Northern Ireland. This will be the first nationwide comprehensive breast cancer screening service in the world. We are well ahead of all our partners in the European Community and there are no comparable programmes in nations such as the United States, which spends far more on health than we do. Our system will save many lives and we should be proud of what we are doing and aware of the massive investment which demonstrates the Government's commitment.
We have taken a similar approach to cervical cancer. It is far less common than breast cancer, with about one seventh the number of deaths per year. In 1986, 2,004 women died of cervical cancer in England and Wales. It has been linked in research to smoking and to the number of sexual partners. The significant factor, however, is that this cancer has a relatively long detectable pre-cancerous stage, during which the condition is 100 per cent. curable. Cervical cancer was one of the first cancers for which that was true. We believe that the cancer screening programme that we are implementing should save most of those 2,004 lives. All district health authorities in England have implemented computerised call and recall systems That has been an enormous task. It has meant providing 750 visual display unit terminals; making an investment of £10 million in information technology and computerising 35 million records. The result of that may mean that we shall have a completely computerised system to assist us in all sorts of preventable screening work in future, which, of course, will also cover men.
As a result of the effort, all DHAs are now able to call women who have never been screened before, as well as recalling women who have previously had smear tests; and within five years the system will have invited all women in the age range 20 to 64 who are registered with a GP—all those we can reach, which is around 13 million women. Programmes for cervical cancer screening on similar lines are being implemented in Scotland, Wales and Northern Ireland.
A mass screening programme of a kind has existed since 1966. Its value is shown in the fact that deaths from cervical cancer have fallen by 14 per cent. in the 10 years to 1986, the year for which we have the latest figures. Without the existing system, we believe that deaths would have been much higher and could have risen. The efforts of the Government will ensure much more systematic screening and this should further increase the effectiveness of the services against cancer. Again, Britain is well ahead of the rest of the European Community on this programme and—apart from Scandinavia—is the first major country in the world to implement such a nationwide programme.
We should not underestimate the huge scale of the effort required to detect cervical cancer. Last year, about 4 million smears were done. Many of these were repeats or were done outside the screening programme. About 150,000 were abnormal, but again many were repeats. Most of the abnormal ones showed up non-cancerous infections of varying degrees of severity. Therefore, we are picking up many gynaecological conditions through this system. About 4,000 new cases of cervical cancer are reported each year, many of which do not come through the screening service at all. As I have said there are about 2,000 deaths each year, mostly among older women. It follows that the incidence of this cancer is tiny—a handful of cases in each district health authority each year.
It is important that health care professionals, especially doctors, are aware of these data so that they can reassure women with abnormal smears that the odds are that the condition is not cancer, and whatever it is, it is likely to be treatable. This programme is intended not to alarm people: but to reassure them.
There is one point to make about all our cancer screening programmes. All this money and effort will be wasted if we women do not use the systems properly. There is no need to approach one's doctor or hospital for a test


unless there are symptoms. Everyone will be called in time, and we hope that everyone will respond. If there are symptoms—a breast lump, or a discharge, or anything unusual—the woman should see her doctor at once. She does not need to wait.
Incidentally, it is up to us as patients to ensure that the computer knows where to find us. Now that we have computerised every register in Britain, we are coming up against the problem that some of the registers are inaccurate to an unacceptable degree. If we move house, we should ensure that, along with the post office and the gas board, the doctor knows our new address. In these ways we will have a cost-effective and confident service and save lives.
I should like to deal with one or two matters on the cervical cancer programme about which women have written to me. I have no doubt that the hon. Ladies in the House will raise these points, so perhaps I can take the opportunity now to deal with them. Many women want to know why we do not reduce the recommended time interval between smear tests from five years to three years. The guidance that we issued in January says:
recall should be at least every five years".
Most deaths occur in women who have never had a smear test. We know that a five-year screening programme can reduce deaths among women screened by an estimated 84 per cent.
For this reason, we believe that increasing the proportion of women being screened at all should take precedence over increasing the frequency of screening. In terms of saving lives, we are trying to get from a very low figure to 84 per cent.—and we are not there yet. That accords with advice given to us by Professor Jocelyn Chamberlain and her team at the DHSS cancer screening evaluation unit, which is based at the Royal Marsden hospital in Sutton.
We are not pressing health authorities to recall women more frequently than at five-year intervals, but we will not hinder them from doing so. I know that some district health authorities have decided to recall after three years. Before DHAs move from five-year screening to three-year screening I would expect them to have satisfied themselves on two points. First, they should be getting a high response from the women in the eligible age range, but particularly from older women who have never been screened before. Secondly, they should be able to run the system smoothly without laboratory backlogs or delays in diagnosis and treatment. We monitor laboratory backlogs very closely.
I see that my hon. Friend the Member for Winchester (Mr. Browne) is in the Chamber, and no doubt he will tell us about one or two laboratory backlogs in his area. As I say, we monitor the backlogs very closely and have been pressing districts to take action where there is a persistent problem. Three quarters of district health authorities do not have any backlog to report.
If we did not insist on these rules, there is a risk that we would overload the laboratories. The same, keen women would come in to be tested repeatedly and we would miss many of the women most at risk and might waste everybody's time and money.
There are other cancers which affect women. The most worrying of these is lung cancer which is rapidly rising. Since 1979, the death rate from lung cancer among men in the United Kingdom has dropped by 6 per cent. but

among women it has risen by 27 per cent., and that is causing considerable alarm. Lung cancer is the second largest cancer killer of women in this country and accounted for 11,000 dead women last year. It looks set to overtake the major cancer killer—breast cancer. The survival rate over five years of women with lung cancer is very poor—betwen 3 and 13 per cent. according to age.
Cigarettes offer women more than the long-term worries about cancer. They interfere with hormone levels in both men and women, and on average lead to the menopause five years earlier. Nobody believes me about that but that is what the research shows. Smoking is regarded as having a role in the increased incidence of osteoporosis. I have mentioned the well-documented link between cervical cancer and smoking. A recent study in the United States of America has suggested that just a few cigarettes a day doubles our risk of heart problems. Worst of all we know that, among pregnant women who smoke, the risk of perinatal mortality is 28 per cent. higher than for a non-smoker. It is also associated with a significant reduction in birth weight by as much as half a pound. The effect of smoking on the baby can be both rapid and devastating.
I suppose that many women believe that smoking keeps them slim, but there are sensible ways to keep one's weight at a healthy level without taking up a habit that stands a good chance of doing irreparable damage to one's health and the health of one's baby. Some people say they smoke to deal with stress, but there are healthy options to deal with stress and most people, including most doctors, have found other ways.
For all these reasons we are very concerned about patterns of smoking behaviour among girls and young women. Smoking has been falling in older women in recent years, but that had not been happening among women under the age of 25. Among secondary schoolchildren in England and Wales, who fortunately still smoke far less than their parents, girl smokers outnumber boys by nearly two to one. As I said in a debate on 23 October, we commissioned research on this to try to find what influences the behaviour of girls in this way. Preliminary results suggest that girls are influenced in a different way from boys.
I have asked the Health Education Council to look at a sustained programme of health education aimed at young people. We have accepted the Froggatt report which recommended:
It is essential that more smokers are encouraged to stop smoking and that non-smokers are strongly discouraged from starting".
We are now considering how best to take that forward. I am pleased to see that the Royal College of Nursing, the largest trade union in the National Health Service, representing about 250,000 women, recently adopted a no smoking policy, as has the Royal College of Midwives and the Health Visitors' Association, both of which have a preponderance of women members. In the DHSS, where we employ about 100,000 people, the majority of them female, I understand that no smoking policy guidelines will soon be issued to local social security offices with the support of the trade unions. We look to see considerable progress there to help all our excellent staff work in a smoke-free atmosphere.
In ways like these we shall continue to do what we can to promote health education and disease prevention campaigns such as those for women's cancer. We watch with interest developments for screening for other


conditions such as ovarian cancer, although we are nowhere near a sound, accurate system that we could use nationwide.
Similarly, we are keen to encourage the development of laboratory tests which are less demanding of scarce staff than the current smear test reading method. However, as my right hon. Friend the Minister of Health said in the Adjournment debate on the organisation Quest for a Test for Cancer on 13 May, any new test we adopt must be cheap, effective, fast, accurate and robust. By robust we mean that it should be capable of being performed in different types of laboratories and by operators with varied levels of skills. I am hopeful that some automated system will come in before too long. I was impressed that a recent meeting of our scientific advisers had 13 such proposals to consider, some of which looked promising.
It might be helpful if I say a word about the growing involvement of the private sector in screening programmes, which we welcome. For a long time preventive medicine was the poor relation in the NHS and we have much catching up to do. The private and non profit-making sectors stepped in to fill the gap and have developed their schemes to the benefit of their millions of members. I understand that more than 150 clinics of various kinds are now in operation. There are two main points I would make to them and their customers.
First, it is not enough to offer simply a testing service. Proper arrangements should be made for laboratory services and to notify the woman's GP that she has been tested and of the results, subject to her consent. That is intended to avoid unnecessary repetition of tests especially as the National Health Service gets it own screening services up and running. Further sensible arrangements should be made for the care, counselling and treatment of women and they should be explained to the customer when she first comes. This also applies to occupational health screening, such as the splendid system that I saw at the Post Office last week, which uses the services, where required, of AMI International and thus relieves the National Health Service of the burden entirely.
Secondly, those setting up such screening systems should be well aware of the good medical reasons why we do not screen younger women for breast cancer. In women under 35, for example, the condition is rare, but benign lumps and cysts are very common. The mammogram used under these circumstances is likely to pick up a high level of false positives, leading to unnecessary anguish until the all-clear is obtained and, worse, possibly to unnecessary treatment. Mr. Ian Fentiman of the Imperial Cancer Research Fund unit at Guy's hospital has expressed his concern about that matter, and I share it. I hope that the reputable companies involved will take note.
We are pleased that the private sector is taking steps to provide a quality assurance scheme supported by a system of registration, inspection and approval. We shall watch that development with interest.
There is no doubt about the growing interest in women's health inside the House and among the population at large. This has led my Department to respond by organising a full-day conference on the subject on 22 June. The many subjects covered will include the cancers that I have mentioned, but the afternoon session will look at conditions which do not kill, but from which millions of women suffer, often silently, such as mental illness—in which women outnumber men—the menopause—problems associated with which were regarded

until quite recently as either imaginary or untreatable—and osteoporosis, the thinning of the bones, which is increasingly filling accident and emergency departments and orthopaedic beds. There will be a session on puerperal psychosis, which is an appalling mental illness that affects some women after childbirth and can vanish as quickly as it came, leaving havoc in its wake in the woman's family. The conference is designed to have learned speakers sharing the latest information with lay people, including representatives of more than 50 women's organisations, and press representatives who write on women's issues and health. Many hon. Members and Members of the other place have accepted invitations to attend.
Since some important new issues will be covered on that day, it will be apparent that the Government want to move the discussion on. We have put our efforts against cancer on a sound footing, but now we must turn our attention elsewhere. Osteoporosis, for example, is a condition which probably affects one woman in four, and is clearly linked to falls in hormone levels after the menopause.

Ms. Harriet Harman: Is the Minister aware that, because of cuts in the district health authority's budget, a consultant in Sheffield has taken out a bank overdraft to keep his unit, which conducts care and research into osteoporosis, going? I welcome the Minister's concern about this issue, but will she ensure that he is given money to run the unit and so that he can pay off his overdraft?

Mrs. Currie: The hon. Lady should beware of challenging me on such topics. I had a healthy supper with the extremely eminent physician concerned on Tuesday night. We discussed some of the circumstances surrounding his work. The press has been less aware of the fact that he receives £700,000 for his research from the Medical Research Council. It was suggested that he might like to discuss what he will want to do in the future with the regional health authority, the district health authority and the Medical Research Council. I believe that that is now happening. The reason why I had supper with him was that I have invited him to be one of the speakers at the conference. The work being done on osteoporosis in units such as the MRC-funded one in Sheffield is important, and I have conveyed that interest to the health authorities concerned. I hope that that answers the hon. Lady's question.
Osteoporosis is 10 times commoner among women than men, and among older women it often shows itself as dowager's hump. Women can lose as much as 6 inches in height a year as spinal bones collapse. One realises when looking around our towns and villages, how many women suffer from that painful and disabling condition. I see that my hon. Friend the Member for Billericay (Mrs. Gorman) is in her place primed to give the answer. She is aware of the close interest that my Department is taking in the work of the Amarant trust, which she chairs, and which advocates hormone replacement therapy. My hon. Friend will, I know, understand our caution about any treatment which involves drug therapy over a long period. hope that she will also feel able to support and advocate those preventive measures, which are emerging from research, as the best advice to women, particularly before they reach menopause: do not smoke and stay physically active so that the bone mass is maintained. There is evidence that bone mass is significantly greater among women who take


regular exercise than among those who do not. Even for post-menopausal women, exercise can slow down the rate of loss, or even reverse it somewhat. So, I am afraid that it is on with the tracksuits girls, and leave those fags at home, and I invite all hon. Members to join me. Incidentally, HRT, where appropriate, is available on the National Health Service. Patients are not obliged to seek private treatment.
Among the other organisations that are interested and involved, we help the National Osteoporosis Society, the Women's Aid Federation,—the battered wives organisation—and Maternity Alliance. We grant-aid the Widows Advisory Trust, the Miscarriage Association and many other organisations. Our male colleagues would be surprised if they saw a list of the wide range of groups concerned with women's health that we support.
The other main chunk of work carried out for women, which has experienced important developments lately, is maternity care. As it will not be one of the subjects discussed at the women's conference, I shall spend a few moments considering it. Since 1981, following the Social Services Select Committee report on perinatal mortality, vigorous efforts have been made to improve services. We set up the maternity services advisory committee, which published three reports under the title "Maternity Care in Action". The first, in 1982, was entitled "Antenatal Care", the second, in 1984, was entitled "Care during Childbirth", and the third, in 1985, was entitled "Postnatal and Neonatal Care". Those reports are a comprehensive guide to good practice and a plan for action for health authorities.
The resulting improvements in perinatal mortality are well-known. Between 1979 and 1987, the death rate among babies in the first month after birth dropped from 14·6 per 1,000 live births to 8·9 per 1,000 live births. It is more revealing if we look at absolute numbers. In 1979, there were just over 600,000 births and nearly 5,000 stillbirths, whereas in 1987 there were 645,000 births—many more pregnancies went to full term—and only 3,200 stillbirths. Far more babies are being born alive. We had therefore about 40,000 more babies to care for last year than in 1979.
Similarly, the chances of survival of tiny, low-birthweight babies have improved dramatically. In 1976, there were 38,000 births below 2·5 kg—about 5·5 lb—of whom 84 per cent. survived. In 1987, there were over 45,000 births below 2·5 kg, of whom 92 per cent. survived. Many thousands more tiny babies now survive every year. The amount of care needed to achieve that success is enormous. The object of the exercise is a healthy baby and a contented mother and family.
Over a 10-year period—indeed, a 20-year period—some matters have not improved. In 1976, the number of low-birthweight babies born alive represented about 6·5 per cent. of the total. In 1986, it was 6·8 per cent. The figure has been about 7 per cent. for over 20 years. The failure of the these statistics to change is a matter of considerable concern. Low-birthweight babies are far more likely to be sick babies in the future. They have a far higher death rate in the first few months of life, when they seem especially prone to infections.
In some parts of the country, such as Leeds, which I visited last year, the proportion of low-birthweight babies is over 9 per cent., yet in Scandinavia it is 3 per cent. In

Scandinavia, a higher proportion of babies go to full term and are born at full weight. We do not know why our figures are so high, except that perhaps there is a link with smoking. A drop in the birthweight of the baby and increased perinatal mortality are directly linked to the number of cigarettes smoked. Therefore, heavy smoking is likely to produce a stronger effect.
We undertook a survey of health authority maternity care in 1985 following the MSAC reports, but we propose to write again to the district health authorities in England and ask how they are implementing MSAC. This time we shall particularly look at the antenatal care side and at the levels of care in the community. We are looking for responses within less than 12 months.

Mrs. Margaret Ewing: The hon. Lady referred to care within the community. Is she aware of the deep concern in rural parts of England, Wales and Scotland about the large number of general practitioner units that have been closed that offered very effective neonatal and maternity care to women, without their having to travel long distances to high-tech centres?

Mrs. Currie: Yes, I recognise that fact. When we receive responses to our new survey of antenatal care, we shall consider the extent to which we can provide out-patient care as close to home as possible, while at the same time enabling women to have access to the latest facilities in the services that are most appropriate to them. There may need to be more of a division between facilities. I shall refer later to isolated units.
Much of the improvement in baby mortality is well known. What is less well known is the sharp drop in the death rate of women in childbirth that has accompanied all these improvements. Forty years ago, when I was born, the number of births a year was roughly the same as it is now, but some 700 women died in or soon after childbirth. Even 10 years ago it was 74, a rate of 12 per 100,000 live births. Now it is seven per 100,000 live births, but, at 45 cases in the most recent year for which we have figures, it is still too many. Nevertheless, it shows a continued improvement.
We have given a lot of thought to this subject and we have done a lot of work on it. I attribute much of this welcome change and the drop in the death rate of babies and mothers to our efforts in maternity care. It has involved far more women giving birth in hospital. Most now follow the recommendation that births should take place in modern hospitals that provide a full range of services, including anaesthetics and a paediatrician on call. I recognise that, where they still exist, people say that they like small, isolated maternity units, but we are still advised to move away from delivering women in such units.
Such advice was included in a recent publication of the National Birthday Trust Fund. I believe that it is wise to continue to take that advice. Fewer women and fewer babies are dying. The results have convinced me. I am also convinced that it should be possible—that in fact it is essential—to provide modern maternity care in a way that is both professional and friendly. I say that firmly.
I referred to sick babies. When a child is ill, the presence in hospital of the mother or another close relative may be an essential element in the child's recovery. I agree firmly with the National Association for the Welfare of Children in Hospital on these matters. I hope to be able to issue new draft guidelines for consultation within the next four weeks which will update those issued in 1972. The hon.


Member for Peckham (Ms. Harman) knows that that fulfils a promise that I made in Committee on the Health and Medicines Bill.
The last topic that I want to cover is still concerned with women and their babies. It is breast feeding. This week, we made an announcement that is of considerable significance. Since 1980, the proportion of women breast feeding has stood at around two thirds, but the most recent survey in 1985 showed that, while 85 per cent. of educated and social classes 1 and 2 women breast-feed their babies, only 45 per cent. of social class 5 do, which is rather the reverse of what I should have expected. In January, we published the latest report on infant feeding from the Committee on Medical Aspects of Food Policy, entitled "Present Day Practice in Infant Feeding: Third Report." It affirms:
Breast feeding from a woman who is in good health and nutritional status provides a complete food which is unique to the species. There is no better nutrition for healthy infants both at term and during the early months of life.
The significance of that for us today is that there is plenty of medical evidence that natural feeding is better for both the baby and the mother. It returns her to normal far more quickly. It also helps to cement a very special bond between her and her baby, to their mutual advantage. I have to confess that it is also very nice, so we want to promote it.
I have therefore agreed to support a new initiative to promote breast feeding around the country by the National Childbirth Trust's breast feeding promotion group, the La Leche League and the Association of Breastfeeding Mothers. We will grant aid these bodies for a sustained campaign among health professionals and mothers. We expect to spend at least £100,000 over the next two years. In addition, the infant and diatetic foods association of the Food and Drink Federation, whose members make infant formulae, have agreed this week to provide an additional £30,000 this year, and possibly next year as well, to help with the printing and dissemination of suitable breast-feeding literature, posters and so on. I think that that is a remarkable gesture, and I congratulate and thank the association.
But the manufacturers have done more. They have agreed to phase out by the end of this year all free samples and subsidised supplies of baby milk to hospitals, thus closing an important loophole. The bottle and teat manufacturers have agreed to consult on ending their advertising to the general public along the same lines as the baby milk manufacturers. I accept with gratitude the good wishes of the hon. Member for Stoke-on-Trent, North (Ms. Walley), who is smiling. All these changes bring us into line with the World Health Organisation's requirements on marketing breast milk substitutes, promulgated in 1981 and strengthened in 1986. We shall be revising the relevant NHS circular. We intend to issue the new version in the autumn when the manufacturers issue a revised complementary marketing code—I hope in time for a major seminar on 18 October—which will launch the new breast-feeding promotion initiative.

Ms. Harman: Does the hon. Lady accept that one of the concerns of midwives is that the shortage of midwives, and the extra pressure in maternity units because of the cuts in maternity beds at a time when the number of births is increasing, means that midwives do not have the time to help mothers to establish breast feeding? We welcome the hon. Lady's interest and concern and we share her concern about the drop in the percentage of women who are breast

feeding their children, but that makes it crucial for midwives to have enough time to help mothers to establish breast feeding. They feel, and I share their view, that they do not have enough time because of the growing crisis in maternity wards that has been caused by financial pressures.

Mrs. Currie: As the hon. Lady knows, because I have responded to these points on numerous occasions, the number of midwives is increasing. What is more important, the proportion of qualified staff has risen sharply. Therefore, I am content that the National Health Service and the professional side are devoting the appropriate level of resources to this subject. We must ensure that the health professionals realise how important and valuable it is to assist women.
However, the evidence suggests that much of the help, support and encouragement for breast feeding comes best from other women in the same neighbourhood and with the same accents who have been doing it and who are therefore conscious of the pleasure that it gives and of some of the difficulties—and how to overcome them. In that sense, I hope that the new campaign will be directed at both the professionals and, through the voluntary movement, at the women concerned.
We think that we can make considerable progress. Then we shall be able truly to say that we will be promoting breast feeding as best for both the baby and the mother. I cannot conceal my delight that we are making progress in this way on an entirely voluntary basis. It puts us well ahead of the rest of the European Community and most of the developed world.
We are most emphatically not complacent. There are still far too few women who never book their confinement and who first appear in an advanced stage of labour, often too late to save their baby. There are still too many women who die in childbirth. There are far too many women who have never had a cervical smear test, and I fear that there will be always some who refuse. There are too many doctors who dismiss women's menopausal symptoms. and too few of them advise their women patients on how to avoid thinning bones—osteoporosis—in the first place.
There are too many women, particularly among the young, who dismiss our warnings about smoking. Most of all, there are still far too many women who suffer in silence when they should be seeking help. Often they wait until it is too late. The House should firmly reject the notion that a responsible women cares for her family's health but neglects her own. Today's wife and mother knows that her family need her to be fit and well, as does her employer, if she is to meet the increasing demands that are now placed upon women in this country. Our health is in our hands. I hope that all generations of women will in future take a positive and informed interest in their own health.
The programmes that I have outlined make me feel very proud. I think that we in Britain are lucky to have these opportunities, and I commend the programmes to the House.

Ms. Jo Richardson: My hon. Friends and I are glad that the Government have chosen the subject of women's health for debate. I do not denigrate the value of Friday debates but in some ways wish that the debate could have been held in prime time during the week, when more hon. Members could have been here; I know that


many hon. Members have to get away on Fridays. Nevertheless, I am glad to see that a representative number of hon. Members are present.
Doubtless the Under-Secretary of State for Health and Social Security will recall that we had a debate about cervical cancer screening during our recent proceedings on the Health and Medicines Bill. We now have the opportunity to consider all aspects of women's health and to identify and discuss some of the problems facing women, especially women who have little money and who are hampered in trying to live a healthy life. I am a little disappointed that in the catalogue that the Minister gave us, she took a rather blinkered view in some respects; she confined her remarks to the medical aspects of women's health without considering the social causes that often lead to women's ill health. Nevertheless, the fact that the Government have chosen women's health as the subject of this debate is an acknowledgement of the fact that they have begun to take it much more seriously. In that regard, I pay tribute to my hon. Friends the Members for Holborn and St. Pancras (Mr. Dobson) who did much as shadow Minister for Health and to my hon. Friend the Member for Peckham (Ms. Harman) who is doing much now to push the Minister to accept various schemes.
I begin by firmly dismissing the Minister's oft-expressed contention that many of the problems of women's health are women's own fault. The hon. Lady is very fond of expressing herself in lurid language. She has not done so today, but she would acknowledge that she frequently does. I wonder whether she realises just how hurtful that lurid language is to women struggling in an unjust society to maintain their families and to keep them together, to find and keep a job and to cope with bad working and housing conditions. For women who are home workers the last two often go together. There was an interesting article in last Sunday's edition of The Observer dealing with the problems, including health problems, facing home workers. I shall do no more than quote the remarks of a women whose case was cited in that article:
I used to work a 90-hour week to get the money I needed to live. My daughters used to come in from school, eat and start sewing … We were absolutely desperate for money … I challenge anybody to check, sew and label a dozen sweaters at the rate they set and earn more than 66p an hour.
The Minister may think that that quotation is irrelevant to a debate about women's health. However, poverty is one of the conditions that take a toll on women's health. Judging by her speech, the hon. Lady does not even begin to understand that. I hope that she will not mind my reminding her that on 11 March 1985, before she was a Minister, she made a speech on unemployment and industrial policies. She advocated the employment of part-time women workers as opposed to male full-time workers, who she said had all the protection of employment legislation. She also said that full-time male workers
will probably receive holidays and so on."—[Official Report, 11 March 1985; Vol. 75, c. 87.]
The implication is that women can work without the benefit of a yearly break that might help their health. The Government have removed what minimal protection women had and fulfilled the Minister's hopes as expressed in that speech by decreasing the rights of workers and the

obligations of employers. They have increased the risks to women in terms of stress, which has a profound effect on their health.
I shall deal briefly with women's health in connection with work and I hope that my hon. Friends will discuss the matter at greater length. The 9·5 million women now in work account for 45 per cent. of the work force. At work women often cope with equipment designed specifically for men. They suffer from the same health problems at work as men but they are also subject to specific problems such as tendonitis and to the scandals of VDUs. Those are just two of the problems that predominantly affect women. When shopping, I have often noticed the problems faced by women at the check-out and I have discussed those problems with them. They often have to sit in an awkward position on a swivel stool handing goods from the basket on to the counter with one hand and using the other to check up the price. I have noticed that many of them rub their shoulders and complain of back ache. All such factors cause women stress and strain and bad health.
All too often women's work does not end at the factory gate or the door of the shop. Most women still have the sole or major responsibility for looking after the home and many are carers who care for the old, the sick and the young. In recent years many reports have highlighted the problems arising from those circumstances. It is to their credit that most trade unions—notably, the National Union of Public Employees—are taking up with employers issues such as stress and its effect on women's health.

The Minister for Health (Mr. Tony Newton): I have a genuine point, which is not a point of argument. I want to solicit further information. Unless my ears misled me, the hon. Lady referred to the "scandals of VDUs". I would like to know what she meant. As I understand it, a great deal of the clerical work that women used to do—for example that involving heavy filing cabinets—has been made infinitely easier by access to modern technology and the equipment that goes with it.

Ms. Richardson: I shall gladly elaborate. I agree that I used a shorthand phrase, perhaps I should have explained more fully what I meant by the scandals of VDUs. We accept that VDUs have decreased the work load and made the work easier than it was with the old filing and call and recall system. However, I am sure that it will not have escaped the attention of the Minister for Health that VDUs involve health hazards. I do not think that enough is done to ensure that employers take that into account.
The Ministers are looking puzzled. Sitting for too long in front of a VDU can affect health. There is a risk to a woman's reproductive capabilities. I am amazed that the Minister looks surprised to hear that fact, because it is common knowledge. Indeed, many unions and employers have a written agreement limiting the number of hours that someone can sit in front of a VDU, precisely because of that risk. That is what I meant by "scandal", but perhaps I should have said "hazard". It is certainly something that must be borne in mind.
Before the Minister's welcome interruption I was discussing problems at work. The Government have compounded the difficulties facing women through their attacks on maternity rights and parental leave. The


Government preside over legislation designed specifically to encourage low wages and, in some cases, dangerous conditions, and to erode the rights of individuals.
Work should offer the opportunity of better health screening and education and should enhance women's lives. Instead, during the past nine years much gained in previous years has been eroded. On a number of recent occasions, and certainly at some length today, the Under-Secretary has berated women for smoking. She did not refer to drinking today, although she has referred to that and other habits on many occasions. I was stunned when I heard her attributing smoking to the desire of women to keep slim. It is a long time since I heard that one. Most of the women I know who smoke do so because they are under some stress. They do not necessarily want to smoke. I smoke, and I do so because I like—it but that is my problem. I certainly do not do it because of stress.
Many women smoke because of stress caused by poor housing or work or family problems. They smoke not to keep slim but because they are nervous and under stress, and smoking provides some form of release for them. I am a little surprised that the hon. Lady did not acknowledge that. Indeed, it is downright offensive to talk about women in the way that she did and to blame them for seeking relief from tensions that, in many ways, the Government have forced upon them. After all, the Government capitulate to the tobacco and alcohol businesses whenever there is a call for action against advertisements deliberately aimed at the young and at women. Blaming the victim is an obnoxious practice and is always an unproductive and futile exercise.
Does the hon. Lady really believe that women are less aware than men of health risks, or that they are more difficult to educate than men? Does she believe that they are simply more reckless or feckless than men about the lifestyle and health of themselves and their families? I hope that she does not believe that; I cannot believe that she does. However, that is the logical interpretation of some of her outbursts that sometimes, although I am sure she does not mean them to be so, sound almost sexist—until, that is, we place them in the context of the rest of the Government's policies.
The Secretary of State for Social Services presides over a social security system founded on the Victorian values of the deserving and the undeserving poor, while the hon. Lady wants to found the Health Service on the values of the deserving and the undeserving sick. Unlike Conservative Members, the Opposition want all women to have the best available health case and health opportunities, regardless of ability to pay.
The hon. Lady proudly mentioned the role of the private sector in breast cancer screening. I accept that it has a role, but I should prefer all such screening to be carried out within the NHS. A letter dated 4 January 1988 from the London hospital Whitechapel, addressed to one of my constituents, has caused me some surprise. It refers to the first stage of an ovarian cancer screening project in which my constituent had participated. It said that the project had yielded valuable and exciting results that would shortly be published in The Lancet. It said that it would dramatically improve the outlook for the 4,000 women a year who died from ovarian cancer.
To my amazement, the letter's writer said:
There are two ways in particular that early participants in the project such as yourself can ensure its continuation: (1) By helping us to raise sufficient money to complete the project by selling tickets for our 1988 raffle.

It is amazing that a woman who has taken part in a project to help her health and that of other women should be asked to buy a raffle ticket so that other women can also participate. Is that private health care, semi-private health care, supported health care or sponsored health care? We should fund such projects properly and not depend upon people buying raffle tickets.
The Government must fully provide properly resourced services that genuinely promote health, as well as meeting the needs of women when they are sick. Promoting good health means challenging the causes of ill health, such as poor diet, poor housing and homelessness. What about the hundreds and thousands of women currently living in bed-and-breakfast accommodation? That is hardly a healthy life. They are expected to care for their families in one room and they have to leave the accommodation and stay out all day. I do not know how they can be expected to provide a healthy diet in such circumstances. The Government do very little to help those problems. Other causes of ill health are unemployment, unsafe and stressful working conditions in the workplace and at home, the dual load of unemployment and caring responsibilities and poverty and powerlessness.
Every health study has shown that poverty is one of the most important factors influencing life and health chances, so we should not increase the poverty of those who are already the poorest in our society. The Government's record is second to that of no Government this century, as is shown by the first increase on the infant mortality rate since 1970. An article in The Health Services Journal headed:
Why are our babies dying?
states:
A rise in the infant death rate in England and Wales—the first since 1970—is causing concern among community service managers and staff. The most recent figures from the Office of Population Censuses and Surveys (OPCS) show that the number of deaths of children under the age of one, internationally accepted as an important indicator of health and social conditions, rose from 9·4 per 1,000 births to 9·6, an increase from 6,141 deaths in 1985 to 6,313 in 1986 … but initial response from health professionals suggests that social deprivation, not gaps in medical services, is the underlying cause.

Mrs. Currie: The hon. Lady should know that we shall shortly have to hand more recent figures that show that mortality rates have dropped again. They have dropped below what the trend line would have been. That is precisely why I am now so concerned about smoking behaviour in young women. They are the only group whose smoking behaviour is increasing. As I demonstrated, the effect on the baby is immediate and devastating. It helps to cause perinatal mortality and reduce the chances of babies who are born alive.

Ms. Richardson: Again, the hon. Lady has blamed young women who smoke. Smoking may be a contributory factor, but she has not answered the point, which was that health professionals believe that
social deprivation, not gaps in medical services, is the underlying cause
of the increase in that period. I am still amazed that the hon. Lady has not taken that fact into account.
During Prime Minister's Question Time yesterday, there were references to a report from the Low Pay Unit and the Child Poverty Action Group. It showed that between 1979 and 1985—I acknowledge that it was three years ago—the number of people below pension age living


on or below the poverty line rose from 2·9 million to 6·54 million, a rise of 120 per cent. It is no good the Government saying as they tried to do yesterday, that it is an old report and that things have got better since then. I promise the hon. Lady that things have not got better since then. The figures have not dropped—in fact, they will get worse. With the poll tax, more people will drop into the poverty trap.
The hon. Lady referred with pride to working with the Maternity Alliance and other organisations. I am glad that she acknowledges their worth. Four years ago, the Maternity Alliance produced a report called "Poverty in Pregnancy". The report looked in detail at the basic requirements for a healthy, nutritional diet for pregnant women. It concluded that pregnant women whose income came from benefits and those in very low wage families had incomes which were clearly insufficient to buy an adequate diet which would ensure their own and their babies' future good health. It estimated that benefits needed to be increased by at least one third, that the maternity grant needed to be restored to its original value, which at that time would have been £125, and that the seriously inadequate welfare foods policy needed radical improvement.
We have certainly had radical change since then, but we have not had radical improvement. The social security review has cut benefits and removed one of the most vulnerable groups—the under-16s—from any benefit. At one time, the maternity grant, albeit at a low level, was universal. It is now available only to those who are on benefit. Free school meals have gone, and welfare foods have been cut.
Does the Under-Secretary really believe that such actions—and by her own Department, too—are the right way to ensure that women have a good start for themselves and their families and have a healthy life?
The feminisation of poverty is not a new phenomenom. The hon. Lady quoted some women's journals from perhaps 100 years ago. At the beginning of the century, 60 per cent. of all Poor Law recipients were women. In 1988, 60 per cent. of all income support recipients are women. It is truly staggering that things have not changed over 88 years. Three quarters of the low paid are women. Yesterday's copy of The Independent contained a whole page of little bits on regional trends that were recently published by the Government. The article is headed:
Women's pay still lags behind
An extract states:
Progress towards equal pay appears extremely slow. Women's pay still lags far behind men in every part of the country, irrespective of prosperity.
The highest-paid women are in the South-east, where average weekly earnings are £167·60p, is well short of the earnings of the worst-paid men, who are in Northern Ireland and take home an average of £190·40p.
Women in manual jobs fare worst of all, averaging only £115·30 a week—£70 less than their male counterparts. Although these are full-time jobs, more than half the women so employed in East Anglia and Northern Ireland earn less than £100.
All those factors are relevant to our discussion about women's health. Thousands of women actually have to earn their poverty by working in the NHS and related local authority community services and subsequently get as a bonus ill health and a lack of opportunity to choose a

healthier lifestyle. I refer to nurses, therapists, administrators, technical workers, caterers, cleaners, laundry workers, home helps, day care and respite care workers, and, of course, the millions of unpaid carers at home, who are often isolated and unsupported in caring for their loved ones and who had to fight the Government through the European courts for financial recognition. All such people are low paid and below the threshold laid down by the Council of Europe.
We have just received an important report from the Policy Studies Institute on doctors and their careers. That report was commissioned by the DHSS. [Interruption.] The Under-Secretary points to herself. It was commissioned by her. I hope that she is interested in the results. So far, I have managed to read only the shortened version, as the longer one rather defeated me in the time available.
The pattern of discrimination and career prospects for women doctors mirrors the picture that we see everywhere. If there is a hierarchy, women are in powerless positions. If there is a grading structure, women are at the bottom of it. If there are pay differentials, women are on the lowest rates. The description of the effects on women doctors of working in the Health Service hold true of women in all professions and all women working in health and community services. The report states:
Exhausting and stressful hours of work"—
Perhaps hon. Ladies will include the House of Commons in this—
disrupted or non-existent family and social life, endless exams, the repeated scramble for short-term jobs that involve moving around the country, inflexible career structures and the increasing importance of patronage from powerful, and usually, male senior doctors, all conspire against women.
With the addition of a few substitute words, we could adapt that paragraph to refer to the House of Commons. However, that is a quote about women doctors, though it applies across the board in most professions. Yet, as we know, access to a woman doctor is now one of the most frequent requests that women voice with regard to their own health needs. Information on the availability of a woman GP is one of the most frequent responses made by a family practitioner committee, yet the Government's White Paper, "Promoting Better Health- will threaten the availability of women GPs and the services they offer. I do not know whether the Minister has seen the response of Women in Medicine. I assume that she has. It is a responsible organisation of women doctors and says that many of the proposals threaten the availability of women GPs and the services they offer.
The White Paper does not recognise or reward those aspects of work, often done by women GPs, which cannot be easily measured, such as the many forms of counselling. Instead, its emphasis is on a few countable targets, eg immunisations and cervical smears. Indeed, women could well be employed specifically to work in these limited areas of practice. They would lose job satisfaction, be inaccessible for consultation on other matters, and their wide range of skills would be wasted.
Changes in the way doctors are paid would encourage GPs to have more patients on their books. This would mean less time could be spent with each individual. Women, for a variety of reasons, on average consult their doctors more often than men do, and with more complicated problems. They, therefore, would be the hardest hit. …
Proposed changes threaten to remove valuable allowances from doctors who work reduced hours.
I hope that the Minister will take those views into account.
Support among women throughout the country for well woman centres has grown enormously. The services are run by women for women. Health education and mutual


aid are provided in a positive and supportive manner. Well woman centres adopt an approach which encompasses the whole person rather than a set of symptoms. The whole person in her environment and its impact on her health is considered. That includes income, access to child care and community care, employment or unemployment, housing conditions, diet and the availability of healthy food in local shops and the sufficiency of income to buy it. All of those matters can be discussed in a well women centre.
I know that the Minister is a avid fan of healthy food. We all are, or ought to be.

Mrs. Currie: Yes.

Mrs. Teresa Gorman: I like hamburgers.

Ms. Richardson: So do I, but we must remember that traditional healthy food such as wholemeal bread is more expensive than the white plastic bread which most families have to buy. When the Minister talks about healthy food, she sometimes ignores many women's poverty.
A friend of mine lived in Brixton until recently—she moved because she changed jobs. She is a vegetarian, and tells me that she found it extremely difficult to buy her kind of healthy food in Brixton. Wholemeal bread and yoghurt for example, were difficult to find in the supermarkets because they are too expensive for the people of Lambeth to buy.
I did not hear the programme, but I understand that the Minister was on the radio yesterday introducing a recipe book. I do not know whether she wrote it herself, but I understand that it costs £14, which is quite a lot.

Mrs. Currie: It is a book for caterers.

Ms Richardson: I suppose that we are not intended to see it.

Mrs. Currie: The hon. Lady may not be aware that the book of recipes that we launched yesterday is not really intended for the general public—it is a caterers' book. Caterers repeatedly request that we provide recipes that accord with the latest recommendations. We have done just that.

Ms. Richardson: Perhaps we can have one in the House of Commons. It sounds a good idea and I hope that caterers in hospitals, who the hon. Lady says have asked her to produce the book, will be able to afford the ingredients on their reduced funding. We should not simply say that people should buy healthy food—we must remember its cost.
The development of mobile and workplace health care and screening facilities are another development of women's own work and campaigning to improve the quality and quantity of health services. I pay tribute to the work of women in what may loosely be called the women's health movement and to the trade unions who have played an important role in persuading employers to make workplace screening available. It has often been a long and difficult task, as the campaign for workplace screening in the House shows. We are now to have it at last.
I trust that our next success will be workplace child care, out-of-school care and parental and family leave as of right. One day we may get this place into shape. An integrated approach to economic, social and health policies is essential if we are to promote good health and well-being for all women. That is what the Government and the hon. Lady are failing to do.
One-day seminars and one-off conferences are utterly insufficient. I apologise to the Minister for being unable, for very good reasons, to come to her conference on Wednesday. I know that she was anxious to make her announcement. I do not believe that such conferences have the power to embark on the cross-departmental action that is needed. They are useful in their own way—I am not patronising them or putting them down—but I would have preferred it if the hon. Lady had called a cross-departmental conference to consider the medical aspects of women's health, and the social causes of their problems to see how we can bring the whole thing together.
Women are the majority of NHS consumers because of their own health and because of their caring responsibilities for others. A wide range of health care needs and problems are experienced exclusively by women, such as maternity needs, menopause, pre-menstrual syndrome, post-natal depression and problems arising from use of the contraceptive pill or the intra-uterine device. In spite of the catalogue that the Minister gave us in that respect, the Government's policies are robbing and short changing women.
The NHS collects no data on the ethnic origin of patients, so the extent to which it meets the needs of women from ethnic minorities is difficult to judge. We know, however, that research on conditions such as sickle cell anaemia and thalassaemia, which are life-threatening in some cases, has been given a low priority.
Similarly, we have been too slow to respond to the needs of women for whom English is not their first language. As we all know, communication between doctor, nurse and patient is essential to confidence and good care. The London borough of Hackney is an excellent example of good practice. Its multi-ethnic women's health project employs five part-time workers, speaking Turkish, Urdu, Gujerati and Bengali. That ensures two-way communication, not just to explain the procedures to patients, but to assist in an exchange and dialogue between health workers and patients.
The Government's policies have cynically and deliberately engineered a crisis in the Health Service so that they can introduce market forces and further privatisation into our health system. The impact on women's health of those policies has already been dramatic and detrimental. Hospital and bed closures have reduced gynaecology beds by 10 per cent. obstetric beds by 8 per cent. and GP maternity beds by 40 per cent. The lengthening waiting list, as a result of the loss of beds for children and elderly patients, means that women are providing even more care at home, losing work time and income and suffering even greater stress.
Last Friday a woman came to see me about her 78-year-old mother whose legs had finally given way so that she could no longer walk. The mother weighs 17 stone. She is confined to bed. She needs a bed from which there is a hoist so that she can pull herself up, and then her 78-year-old husband can help her on to the bed pan. That is a fairly familiar story. A nurse visits three times a day simply to help with those bodily functions. However, most of the caring is down to the 78-year-old husband and the daughter.
I spoke to the health visitor on Monday. She said, "It is a tragedy, Ms. Richardson, that we do not have more of these beds readily available." We must depend on people such as my constituent, the daughter, who not only has to do these extra duties, as well as trying to maintain a full


time job to keep her own family, but who feels a terrible sense of guilt about her mother—guilt that, perhaps, she has not done enough. We too infrequently acknowledge the great debt which we owe carers in our society, who have saved the health and community services so much money.
Special care baby units have suffered an 8 per cent. cut. The crisis in community care is rapidly approaching a position of community neglect.
The cervical cancer screening programme on which the Under-Secretary has given a lot of information is, frankly, a shambles. I have written to the hon. Lady telling her that I have already received information on this matter. For example, I am told that in Winchester and Basingstoke the computer call and recall system that came into operation only on 1 April this year is already out of action and cannot be restored because of lack of resources. I am also informed that call and recall letters will not be sent out, regardless of the problems with the computer, because the laboratories cannot cope with the backlog of smears already awaiting inspection. The hon. Lady must know that this is a pattern that is occurring all over the country.
There are similar fears about the much-publicised initiatives on breast cancer screening. Experts in that sector have already said—as they have about cervical screening—that the age at which screening begins should be lower. Today the Minister tried to justify why that should not be so. However, on balance I prefer to agree with the experts. We must aim for three-yearly intervals between screenings rather than five yearly. As I have said, I hope that the Under-Secretary will also look carefully at the shortage of specially trained radiologists and surgeons. All those matters cast grave doubts on the quality of that service.
While such doubts and uncertainties remain, thousands of women will continue to die needlessly. Money—the one thing the Government never want to discuss in debates on the National Health Service—is the major answer: money for training, money for more staff, money for laboratories and clinics, and money for further and continuing research. I am sure that the hon. Lady did not intend to delude women into thinking that all is now well with the programmes for cervical and breast cancer screening, but she appeared to suggest that. That would be unfair. Many of the women whom the hon. Lady wants to see screened will not even be called for screening until 1992. Will she tell us how many women will not be called until 1992? I am sure that she does not know the answer. Perhaps it is incalculable.

Mrs. Currie: Perhaps the hon. Lady might do the sums for herself. I said to her that through the screening service we expected to make contact with about 13 million women in this country. We expect to call them in approximately equal tranches over a five-year period. I also said that anyone who has never been called for screening—I have made this point on many occasions—can come in at any time. We tell people that if they are symptomless, there is no need to worry. I am content with that. It would not be possible to call in 13 million in the next six weeks and screen them all at once.

Ms. Richardson: I do not think that the hon. Lady has answered the point. We can all do our calculations. She

says that women can come forward at any time if they wish to do so. As the Minister herself has pointed out, women do not always think about the necessity of doing so. Sometimes they do not do so until, unfortunately, it is too late. However, if they did all come forward at the same time, the entire system would snarl up. It would not be possible to cope with all those women because there are not enough laboratory resources or staff to check the smears. Unless more resources are provided, there will be women who would not be called until 1992, and many of them may die in the meantime.
Similarly, family planning services that have contributed so greatly to women's improved health, and again were fought for by women and brought into the National Health Service by a Labour Government—I am proud to say—are being cut. The hon. Lady has said that she would be concerned if the family planning service disappeared or was substantially cut. At least, 25 districts have made cuts in their family planning services already, according to reports from community health councils and family planning regional offices. All the available evidence shows that more districts are planning cuts.
Any Government who were genuinely interested and concerned about this matter would urgently intervene to prevent the inevitable increase in unplanned pregnancies that will result from such policies. Ironically, they will also create long-term increased social and economic costs. It is a short-sighted and narrow approach which plagues every aspect of the Government's policies. The obsession with cash limits, charges and market forces distorts every section of the Government's White Paper on promoting better health. They end up by addressing the wrong agenda and issues and, therefore, come to the wrong conclusions.
The Minister should be chairing an interdepartmental committee covering employment, her Department, housing, the environment and transport. The committee should cover all Departments. It should examine broadly what contributes to bad health in women and in men. The hon. Lady is the appointed Minister for women's health, and we are all glad that the Government have acknowledged that there is a problem and have appointed a Minister to deal with it. That will not be done, however, within the blinkered confines of the Minister's Department. I hope that she and the Prime Minister will recognise the necessity for having an interdepartmental link so that we can examine the problem properly and sanely.

Ms. Joan Ruddock: I recommend to my hon. Friend a recent report entitled "Poverty in Lewisham". If the Minister were to chair a committee of the sort that my hon. Friend has suggested, she might find some links that are well illustrated in the report. In three of the wards in my constituency, one in four is unemployed—one in five of the young people is unemployed—and one of every two households is receiving supplementary benefit. My hon. Friend will not be surprised when I say that in two of those wards my constituents are 30 per cent. more likely to be dead before the age of 65 than are those who live elsewhere. In the other ward the figure is 54 per cent. Those figures illustrate that mortality rates are linked directly to poverty, unemployment, bad housing and all the ills that have been illustrated by my hon. Friend.

Ms. Richardson: My hon. Friend, in referring to the borough which she represents, has illustrated what could


be done nationwide if the Minister took up my suggestion of an interdepartmental committee. I hope that she will tell us later whether she is intending to take it up.
Labour's agenda for women's health—it has been set out in one of the best documents that the Labour party has ever produced—has been set by women. It was founded on women's own experience and it built on the ideas and the health projects that women have developed for themselves. Together with our proposal for a ministry for women, the agenda will provide the powerful Government machinery that is needed to ensure that every Government Department is included—for example, the Departments of the Environment and Employment, the Ministry of Agriculture, Fisheries and Food, the Departments of Energy and Education and Science, the Treasury and the Department of Health and Social Security. All those Departments should be monitored. A women's ministry and a health Department under a Labour Government will jointly ensure that the social and economic causes of women's ill health are tackled on every front.
If ever there is justification for the concept of a women's ministry, it rests with the problems of women's health and the necessity for monitoring what is happening in every Department. There must be a central strategy for women's health, and that is what the Government do not have. We would ensure under a Labour Government that all women had the same opportunities to make genuine and realisable choices about their own health and the health of their families and communities. That includes private and community health care. We would work together in teams and in partnership to ensure that there is real choice and the best of health for all. That, in our view, is the way forward. That is the only real hope for the future that women have for themselves and for their families.

Mrs. Teresa Gorman: I congratulate my hon. Friend the Minister on being able to produce the amazing catalogue of measures that the Government are now taking to improve women's health care. She must accept our congratulations on being the Minister who has put the subject on the map. There is no doubt that she whizzes around like an Exocet missile, attacking all areas that might prejudice women and which concern women especially. She is not the only member of the Government, however, who takes a special interest in women's health and general lifestyle. We do not need a Minister to take that special responsibility because we have so many Ministers who take an interest in the subject.
I shall talk especially about mature women and their health care. It is a subject in which I have a special interest, not least because I am one of them. When we are cute little babies, everybody loves us. When we become older and become pregnant mums, everyone cares for us. Who cares for women when they become menopausal? Until recently, not many.

Ms. Harman: Not many men do.

Mrs. Gorman: Perhaps. Women in this age group were often embarrassed and felt guilty. In many instances the approach of others was to this effect, "Well, you are getting old and you must put up with the consequences, just as your mother and grannie did." When the event hit me, as it does every woman eventually if she lives long enough, and I started to experience horrible hot flushes

and other symptoms, I went to find treatment. As my hon. Friend the Minister said in her opening remarks, it is true that women tend to put up with a great deal that a man would normally go to his doctor to complain about. I am one of those real women who usually do not put with things. Accordingly, I went to find help, but it was not easy.
I shall refer briefly to some of the awful things that can happen. There are awful hot flushes, which are embarrassing when one is in a room that is full of people. The woman might say "Oh, my God, it is hot in here." Everyone looks round and says, "It is not really. It is you." It is rather like saying to a crowd of strangers, "I am getting old."
My wrists and ankles began to hurt. My ankles became so painful that I could hardly get to the top of my house—incidentally, it has 70 steps. My wrists became so painful that I could not cut a slice of bread. I had to buy sliced bread. Incidentally, I could tell the hon. Member for Barking (Ms. Richardson) where she could buy good sliced wholemeal bread in Brixton. I drive through Brixton almost every other day and I know where it is possible to buy good wholemeal bread and yoghurt. I am fond of Greek yoghurt. It is possible to buy some good West Indian bread, which is really delicious. It is brown and moist and lasts for ages. I buy it regularly.
As I was saying, I could not cut a loaf of bread because my wrists were so painful. I was running a business and when I returned home at about 7 o'clock I was knocked out, as it were. I was tired, listless, dreary and irritable. Worst of all, I started forgetting things. This meant that I missed appointments. I began to think that if these were the symptoms of becoming old at the age of about 40, I would rather be dead. I felt that I could not face another 30 years of them.
I was fortunate. I am a biologist by training and so I know a little about these things. I went to King's College hospital, which has a menopausal clinic that is one of the most prominent in the world. It is a world leader I got myself on hormone replacement and it reconstructed me. I am a resurrected woman. I would have fallen to pieces had it not been for the treatment.
When I saw the facilities at King's I realised that the opportunity for women to discover the marvellous treatment that has helped me enormously was scant. There are only about a dozen such clinics in the country. I asked those at King's who had helped me how I could help them. They said that they wanted to raise money for a unit that they could make a national research and development centre, and I started getting a committee together to do this work. In the meantime I was elected to Parliament. That meant that everything came out in the open about me—hormones, the menopause and my age. I decided that I might as well go for broke. I wrote an article for a newspaper that was to this effect, "Yes, I am over 50. Yes, I am menopausal. Yes, I have hormone replacement therapy. Yes, it is terrific." The response was 10,000 letters from women saying that they thanked God that someone was talking about the subject. Some of the letters set out horrific stories of broken marriages and women driving their kids mad because they were so irritable. I realised that there was a desperate, crying need to provide help for women in this position.
Since I have come out, as it were, I have met an enormous number of women who are prepared to admit that they receive hormone replacement treatment. These


include Dora Bryan, Dot of EastEnders, Diana Sheridan and many other famous women. I shall not give the House the whole list now. The gynaecologist to the Queen is a big supporter of it. He believes that it can help enormously and is on record as saying so.
My experience has helped to highlight one aspect of women's medicine which was perhaps hidden and secretive, and about which women felt bad. A third of women have these desperately awful symptoms, another third have them fairly badly and some do not have them. One is unfortunate if one's doctor is a woman who has not experienced these symptoms because she will not be sympathetic, nor, I am sad to say, will many general practitioners.
The Minister said that this treatment is available on the Health Service, but that does not mean that a woman will always find a doctor willing to grant it to her. If she does, he may not understand all the nuances. There are about 20 different varieties of hormone involved, like baked beans. She needs a specialist and if her doctor gives her a treatment which does not work or affects her badly, often there is nowhere to go to see a specialist. we need more menopause specialists.
We have 9 million menopausal women, many of whom are suffering symptoms, some of which they can see, such as flushing, but many which go on inside the body insidiously. Outside we may become wrinkly but inside we are growing crumbly. Our bones, arteries and memory are all being affected. There is now masses of evidence, as the Minister pointed out, linking the lack of female hormones which are lost at the menopause with osteoporosis. I am delighted at the support and help that she has given to the National Osteoporosis Society. I am working closely with it and between us we want to set up special places where women can go.
Unseen symptoms include arterial problems. Arteries and veins decay, leading to strokes, which are another aspect of the loss of female hormones. That is being studied at King's College hospital, which also has a unit studying the mental and psychological effects of the loss of hormones. Many women undoubtedly suffer from deep depression and sometimes their doctor gives them tranquillisers or pep pills, which cost a fortune and which the doctor continues to prescribe for donkey's years. They cause side effects. The Minister said that she was not keen on on-going drug treatments over many years. People get hooked on tranquillisers. That is not necessary if more research is done on this subject.
The Minister's answer to osteoporosis is to take more exercise. That may be good advice for those under 40, but there is not much one can do to increase one's bone mass when one is over 40, except perhaps the middle bits. I am assured that the end bits which snap off with wrist and hip fractures are not particularly affected. Incidentally, many people die of jogging.
Some people worry about the side effects of this hormone replacement treatment. Whenever I become enthusiastic about it, which I frequently do, the scare of cancer is raised. We must meet that anxiety and we can probably do more research on that. Many women who have come to our new clinic, which I have helped to open,

are discovered to have other conditions when they come in for menopause symptoms. They can then be sent on for other treatments.
Originally, American women with this problem were given only oestrogen. I do not want to get too technical. That hormone causes the lining of the womb to build up and if one does not get rid of it, as one does naturally when one is younger in the form of a period, it can become cancerous. That was not realised early on, but now it has been discovered and women are given a balance of hormones, similarly to those produced when young, so that the lining of the womb is shed periodically. That is good news for the tampon makers. In that way, women do not risk cancer of the uterus. There is a possible link with breast cancer which is under investigation, but by having frequent checks for hormone replacement therapy, women are more likely to be screened and mammogrammed. I go every six months and have a mammogram there. As far as we know, there is no link between the treatment and cervical cancer.
About a third of all Health Service beds, for example in orthopaedic wards, are used by women with problems linked to the menopause. Heart attacks rocket in older women. They are practically unknown in young women because they produce hormones, but when that stops, the rate of heart attacks in women catches up with that in men. Therefore, many menopausal women, for example, with arterial problems or suffering from strokes, are in hospital care. There are 10 women for every man in institutions for the senile because the menopause has a profound effect on one's mental capacity. Women reach the point, sometimes quite young, when they cannot remember how to light the gas stove. That is hard to believe, but it is true. They forget how to do as simple a task as that. We all know about women arrested for shoplifting and blaming it on their age, and often that is to blame. American evidence shows a distinct link between Alzheimer's disease and the loss of hormones, as witnessed by the number of older women, compared with men, suffering from it. That is a further area for research.
In America, this treatment has been used almost since the last war. At least women know about it there, which British women do not. Perhaps a third of American women take this type of help, so it is not a newfangled idea just to keep women young, although there is nothing wrong with that. If we do not have to get old, why bother? The treatment will not make us live for ever. We will go on for our four score years and 10. I say that because many women are living well into their eighties. We are talking about the quality of life. Are we going to be little old ladies, stooped with osteoporosis, having lost five or six inches in our spine and unable to remember what we did two seconds ago, or are we to be in the fantastic condition of someone like the Queen Mother, who is healthy, articulate, intelligent, bright and active?

Mrs. Currie: I was wondering whether my hon. Friend was going to offer herself as an advertisement for the treatment.

Mrs. Gorman: Why not? This treatment is well worth supporting and investigating.

Mrs. Audrey Wise: The hon. Lady is making an interesting and valuable speech, but I am not clear


whether she is also advocating that the Government should put more resources into this. If she is, will she be explicit about it?

Mrs. Gorman: I am just coming to that point.
In response to my experience I set up a new charity called the Amarant Trust to raise funds for King's college hospital medical school. It would like to set up a national centre to investigate all aspects of this treatment, to make it as effective as possible, and the various ways of administering the treatment. We certainly applied to the Minister for support and I hope that under section 64 she will consider giving us some help. We need about £2 million for the centre where we should like to retrain doctors because few understand the menopause. It is not a special discipline, but it ought to be. I hope that we will put it on the map, and that doctors in training will be given a special course.
I also hope that we shall persuade more GPs to make such treatment available on the National Health Service. However, I certainly do not exclude the possibility of private sector funds. I should like to see a centre in every town, to which mature women can go without embarrassment to talk to qualified nurses, chat about all their symptoms, be given screening and generally undergo a check-up in a friendly, happy atmosphere. While I hope very much that some of the funds will come from the private sector in co-operation with the Government, who cares where the money comes from so long as the project gets off the ground?
This is one of the most important aspects of medical care—preventive medicine at its best. As some doctors have pointed out, it keeps women out of the orthopaedic wards, the divorce courts and institutions for the senile—I hesitate to use the word "madhouses". Those institutions are unnecessarily filled with women who, if they received more attention, could be prevented from reaching such a condition. We could all end up in our eighties as active, healthy and alert as the Queen Mother.
I am happy that the Government are supporting that kind of preventive medicine, and I hope that they will give it more support.

Ms. Joan Walley: It is a great pleasure to be here this morning, with women Members on both sides of the House, taking part in such an important debate. There are few men present, but those who are here seem a bit embarrassed during part of the speech by the hon. Member for Billericay (Mrs. Gorman). I am particularly sorry that the Secretary of State is not present to hear us all speak.
Women's health is not important only to us. It is equally important to our partners, our families, our children and all the people we care for. We must get that point across. I, too, regret that the debate is not taking place in prime time, and that this is not a parliamentary occasion with the Benches packed with the male Members who are in the majority here. Nevertheless, I welcome the debate, and I should like to expand on what was said earlier by my hon. Friend the Member for Barking (Ms. Richardson). We are discussing not merely health but stress, poverty, work and, in particular, the environment—all the issues that promote good health, not just the way in which the National Health Service is used to treat ill health.
The hon. Member for Billericay expressed regret that not enough doctors were prepared to specialise in women's issues. I particularly regret the closure five or six years ago of the South London hospital for women, which was one of the major training grounds for women. We are now beginning to experience the bad effects of that closure. Not many female consultants and medics specialise in the different kinds of women's health care, and that is reflected up and down the country. A report produced last week clearly showed that proportionately very few women make it to the top in medicine.
The Minister said that our health was in our hands. I take issue with that. Some of our health is indeed in our hands, but so many other aspects are in the Government's hands. My hon. Friend the Member for Preston (Mrs. Wise) asked where the money would come from to fund a clinic to help menopausal women, and perhaps to extend the provision to set up well woman clinics all over the country. I do not think that it is enough to say that we do not care where the money comes from. The Government should be providing a lead. An integral part of NHS funding should be the provision of well woman clinics, where women can simply walk in without fear or embarrassment. The reason for a visit may be a means of uncovering all kinds of other illnesses or conditions for which the woman could receive support. That would benefit not only her but her family and her employer.
A range of issues affect women as women. First, family planning services have been cut dramatically. Two thousand unwanted and regretted pregnancies have been occurring every year because clinics are closing down. Women who are no longer able to walk into a clinic and obtain advice have no choice but to go to the local GP, who is often very busy and often male. He may not even be fully trained in contraception, and is more than likely to prescribe the pill as a matter of course—which is the best thing that a doctor can do when he is busy and far too many people are coming to his surgery every morning. There is a clear need for much more direction from the NHS to provide family planning clinics.
Secondly, a woman is likely to have babies at some stage in her life, which brings us to the subject of maternity services. My constituency contains one of the largest maternity hospitals in the country. Recently, I met the midwives who work there, and heard at first hand that, although they have a very good centralised unit—one of the largest in the country—the shortages mean that it is being run on the basis of midwives' good will. There are not enough resources to enable them to provide the full and comprehensive service that they would like to provide.
I did indeed smile when the Minister mentioned her initiatives to encourage more women to breast-feed. But hard-pressed midwives will not be available to advise all the patients who come into the hospital. They cannot tell all the new mothers how important breast feeding is. Short staffing means that it is impossible to provide a continuous service, from the time when a woman first knows of her pregnancy until the time when she gives birth. As the mother of two children, I know that it makes a world of difference for the midwife to be there from the beginning, to be present at the birth and to visit the woman at home afterwards. That gives a new mother the best possible start.

Ms. Harman: Does my hon. Friend agree that solving the shortage of midwives is fairly and squarely the


Government's responsibility? Pay is not the only problem. Midwives complain strongly of the inflexibility of their working hours and the lack of child-care facilities. The Government must take action on all those problems.

Ms. Walley: My hon. Friend has summed up the position admirably. When there are shortages of midwives and other nurses—as we have seen recently in the Birmingham children's hospital—staff must be recruited, but that can only be done if we change the basis of their working conditions, and perhaps enable some of the menopausal women about whom we have just heard to get back into our hospitals and the NHS. That also applies to younger women with children at school. All these issues are vitally important.
I am delighted to see that breast cancer screening services are being set up all over the country. Let me say as an aside, however, that if the Minister is so keen to introduce them and to enlist the help of all hon. Members on both sides of the House, it might have been helpful to receive an invitation to the opening of the one that serves my constituency. I received no such invitation, which is why I was outside with all the other people who are concerned about aspects of NHS funding.
I welcome the introduction of the breast screening services. In Staffordshire the take-up of those services has been beyond our wildest dreams. A 70 per cent. take-up was expected, but the actual take-up was 76 per cent. My main concern is to ensure that, when women have plucked up courage to go for cancer screening, it will be possible to get treatment, should they need it, without having to wait a long time. I am concerned that in the west midlands those women who are receiving radiotherapy treatment have to wait a long time for that treatment and as a result suffer great personal hardship.
Cervical cancer screening is incredibly important. Women are unnecessarily dying of that disease. The problems that have been experienced by my district health authority have had to be kept in the public eye. There has been a considerable delay in processing the results of the tests, but I understand that that problem is now more in hand than it was four months ago. That is probably only as a result of the initiatives that have been taken by local hon. Members, including my hon. Friend the Member for Newcastle-under-Lyme (Mrs. Golding).
I was horrified when one of my constituents came to me and said, "My wife has been prescribed some treatment as a result of cervical cancer, but why is it that there is no laser equipment within the North Staffordshire health authority to provide that treatment? My wife must go elsewhere." When I delved deeper into the matter, I discovered that there are some fortunate district health authorities that have laser technology equipment. In many cases, however, that equipment has been bought as a result of private contributions, fund raising or by individuals taking out an overdraft, as in the case of the Sheffield consultant. The marvellous advances that have been made in new technology should be used to treat everyone who needs help. In the debate about the National Health Service and funding, the Secretary of State must face up to the fact that one must take account of new technology. We should ensure that every district health authority has the necessary equipment for treatment.
In common with my hon. Friend the Member for Barking, I am delighted that, after campaigning since 1982, we are to have cervical cancer screening in the House. That development only occurred because of the screening that was conducted in the House of Lords, the results of which were so alarming that we managed to finally swing the balance and acquire that service in this House.
The Ceramic and Allied Trades Union, the major union for pottery workers, the headquarters of which are in my area, passed a resolution at a recent conference that it should do everything possible to ensure that a well woman clinic was established in north Staffordshire. On a number of occasions, I have made inquiries of the district health authority about that, but it has said that it does not consider that such a clinic is necessary.
I am sure that CATU members will be delighted that they have the full support of women hon. Members for a well woman clinic. I am sure that even the Minister will exert some pressure to demonstrate the importance of such clinics. If we had such clinics I believe that there would be many more of the "reconstructed women" referred to earlier.
I share the disappointment that the provision of school meals has been cut and the fact that marvellous initiatives, such as the healthy eating initiative adopted by Staffordshire county council, are likely to be affected by competitive tendering and as a result of loss of income due to social security changes.
Last week, a dentist in my constituency told me that Stoke-on-Trent is a black spot for tooth decay. I am sure that those of us who are mothers have, from time to time, had a child screaming with toothache. We must take into account the cuts in the school dental service and the recent charges for dental treatment that have been introduced.
It is marvellous that women are living longer. Many women need community care, and in my constituency that care is not available. Local authorities are hard pressed to find sufficient money within the rate support grant for such care. I make no apology for referring to a constituency interest, Westcliffe hospital, an institution which houses a large number of elderly patients. In the past, I have been assured that, if it is closed down, alternative health provision will be made available. I have been informed that the switchboard of that hospital is likely to be closed down, which will create safety problems for the women in that hospital. With regard to mental health care, it is clear that, as a result of DHA cuts, replacement hospital facilities will not be available.
At the moment there is an important debate about the funding of the National Health Service, about which many of us are concerned. I wish that the Secretary of State had been present today so that he could tell us whether he had had much success in his discussions with the Chancellor of the Exchequer. It would be interesting to know the extent of tax cuts that are to be provided for those who take out private insurance at the cost of the services provided by the NHS. Yesterday, I met representatives of North Staffordshire health authority and they asked that I should make an earnest plea to the Government to reconsider the proposed changes to the RAWP formula. As a result of those changes, it will be almost impossible for my area to provide the services that are especially needed for women.
Health care is not in our hands only. It is affected by the money we earn, our housing, working conditions and the environment. Mention was made earlier of a conference on


health care, and I believe that different Departments should be represented at that conference. Exercise and sport are important, but why does the Department of the Environment provide insufficient money for local authorities to provide swimming pools and other services to enable women to keep healthy? Why are creches not provided so that women can take part in sport regardless of young children?
Pollution also contributes to ill health. The Government have been dragging their feet on the introduction of lead-free petrol. There are only two garages in my constituency where one can buy such petrol. Three weeks ago I met representatives of The Society of Motor Manufacturers and Traders. Its report "Into the '90s" contained not one mention about lead poisoning, lead-free petrol and its effect on children and women. Why has the Department of the Environment not made strong representations on this matter?
Why has the Department of the Environment not intervened on playground safety? The tarmac and concrete used on those playgrounds is dangerous and causes many injuries to young children, with which we mothers must contend. Why is the Department not prepared to put safety first?
Will the Ministry of Agriculture, Fisheries and Food be invited to the conference? Will it be asked to look at ways in which food policies affect women? Will there be any change in the labelling of foods so that we know what certain foods contain and therefore whether to buy them—presuming that we can afford them?
What steps will the Ministry of Agriculture take to look at the way in which radiation from Chernobyl gets into the food chain? It has become clear in recent weeks that because of water nitrates the water supply in some parts of the country is not safe for young children and babies. Mothers have been supplied with bottled water because the nitrate levels are so high.
Will the Ministry of Defence be asked to make a contribution? RAF Swynnerton is near my constituency, and radioactive substances have been used in exercises. What effect does that have on children's health? I ask that in the wake of the scientific report published earlier this week about the incidence of leukaemia in areas close to Dounreay. What is the Department of Trade and Industry doing about unsafe goods on sale and about the baby walkers that we heard about this morning? Why are there not more prohibition orders on unsafe goods and why is the Department not looking at imports? The Department should be concerned with ballpoint pens whose precise measurement means that if a child swallows a pen top it is likely to choke. We must look at all the issues about product liability and consumer legislation.
Transport has already been covered. Many women cannot live a full life and their mental health is affected because they are confined to the home. Pensioners in Burslem in my constituency cannot get to the health clinic because the bus service stops at a certain hour at night. There are constant complaints from people about such things.
I should like the junior Minister to take on board a few points about women workers. I have had representations about the effects of maternity pay on contractual payments. Some time ago I said how important it was that new mothers should get the best possible start to motherhood. That includes the importance of maternity pay to assist mothers through this difficult although very

exciting time. Constituents have told me that because of the way in which maternity pay is assessed, a woman worker sometimes receives perhaps two weeks' holiday pay on the same day, but she may get more than that. or she could end up with 60 per cent. of the amount to which she is entitled. In my constituency, women sometimes get £90 or £67, while other women in the same factory receive perhaps £110. That is wrong. Women need the maternity pay to which they are properly entitled.
One of the things that has saddened me over the last nine years is the reduction in the Health and Safety Executive's ability to enforce good, safe standards of health and safety in the workplace. One of the industrial diseases that is especially prevalent among women pottery workers in my constituency is tenosynovitis. I pay the greatest possible tribute to the wonderful work of women pottery workers. Government Departments need to do more research into this important industrial disease. Why have we not had legislation about ways in which people move and carry things in the workplace? Those issues are important.
I hope that some of the many valuable contributions by hon. Members today will not be lost. This debate will not be left after today because we shall press these matters and bring them to the attention of the public at every possible opportunity.

Miss Janet Fookes: I welcome the decision of the Government to allocate to one Minister special responsibilities for women's health. It is quite clear from the debate and from what we know from experience that the topic certainly needs to be spotlighted because it tends to be underestimated and overlooked.
The debate has ranged so widely over the possibilities that might come before the Minister that there is a danger of diluting her activities and those of her Department. It would be wiser if some of the matters discussed could be allocated to the Departments in which they more properly lie and if we could have somebody in each Department to look at matters from the woman's point of view. That might be a more practical way of following up some of the points that have been made.
I should like to turn to those elements that are clearly the responsibility of the Department of Health and Social Security. I warmly welcome the emphasis that is now being placed on preventive medicine. It is not before time, because it has certainly been one of the most neglected aspects of medicine. I was always brought up to believe that prevention was better than cure, and I am glad to see a conversion to this approach and that we are dealing on a far better and more systematic basis than ever before with the various forms of cancer that afflict women.
Men should not be left out of the concept of preventive medicine. It would be wise if we considered the concept of both sexes, although I recognise that there are special women's illnesses that require very special attention.
I hope that women will come forward and co-operate in schemes that are now under way for testing for cervical and breast cancer. May I offer one small word of caution? Several months ago I conducted a mini campaign in my health district to encourage women to come forward for the cervical smear test. I was horrified to discover that although the authorities were ready to welcome them,


there was a distinct reluctance on the part of many women to come forward and have the test. There almost seemed to be a suggestion that there was something shameful about doing so or that women were too embarassed to go through the very easy process.

Ms. Harman: Does the hon. Lady think that the Minister's comments that cervical cancer is increased by screwing around increases the reluctance of women to come forward for cervical cancer smears? Does the hon. Lady agree that the comments of the Minister that women should not screw around discourages women from coming forward because they feel a sense of shame?

Miss Fookes: My hon. Friend the Minister has a turn of phrase which is not always the one that I would use, but that is for her to decide.
It is important that women are encouraged to come forward. I made it plain that I had undergone this test, that there was nothing to it and that I would continue to have it regularly in the hope that as a woman in public life I was not simply urging other people to do what I was not prepared to do myself. That is a more effective encouragement.
I do not know whether my experience in my own limited area is common in the country as a whole. My hon. Friend the Minister will know better than I whether there is any widespread reluctance to undergo these tests on the scale that we think is necessary and proper. If my experience is symptomatic the matter needs to be looked at in health education measures and in public discussions.
I think it is correct to say, but perhaps the Minister will correct me if I am wrong, that young girls who engage in very early sexual activity have a statistically greater risk of contracting cervical cancer. If that is so it should be dealt with by health education for the young. It is not a matter of which anyone would immediately think, especially youngsters who have been brought up to think that there is nothing morally or practically wrong—contraception has developed—in engaging in early sexual activity. I look forward to hearing a reply about that from my hon. Friend the Minister.
The newer techniques that have been developed with breast cancer do not involve the drastic amputation that many, perhaps all, women have dreaded and have found so difficult to come to terms with when it happens to them. I am not sure that those newer techniques are always embraced by the medical profession. The Jeannie Campbell appeal, which has contacted all lady Members, has been campaigning for less drastic methods where they are suitable. In a recent letter, the appeal chairman, Peter Hawkins, says:
I am extremely disturbed by the increasing number of cases being brought to my attention in which breast cancer patients actually have suffered, or have been threatened by, unnecessary breast amputation.
In the majority this has been because the possibility of alternative conservative treatment was never discussed between diagnosis and mastectomy. In an appalling minority the patient was found, after 'automatic' mastectomy wrongly had taken place, never to have had breast cancer in the beginning.
At the end of his letter he expresses his worry about the all-embracing consent form that patients must sign before having an operation. My hon. Friend the Minister should consider quickly, if she has not done so already, the terms

of the consent form. There is nothing worse than giving general consent but discovering that the operation has been carried out in a way to which one would never have consented had one been aware of the full implications. If such a thing happened to me, I would be furious and boiling mad. It would be, however, too late and could not be redressed. I urge my hon. Friend to consider that as quickly as possible.
My hon. Friend the Minister did not deal much with stress-related diseases. It is a matter that the hon. Member for Barking (Ms. Richardson) had in mind when she gave her survey of what may lie behind women's ill health. It is true that many women are subject to much stress because of work, unemployment or family problems. They should never use excessively tranquillisers and sleeping tablets as an updated version of a medieval cure. I hope that the medical profession is far more aware of the dangers of long-term addiction to what appear to be harmless drugs and that it is far more wary of prescribing them.
I was shattered to be told by an organisation called Broadreach House, which operates in the Plymouth area and specialises in drug and general chemical dependency, that it found it more difficult to wean members of both sexes off such drugs than it did to wean people off heroin or the other so-called hard drugs. Unless tranquillisers are used on a short-term basis to deal with a crisis in a woman's life or health, they are worse than what they are supposedly trying to cure. We must be far more wary of prescribing them and we need a health education programme to explain to women the dangers of using them.
On many occasions, women have visited my constituency advice bureau and said, almost as a matter of course, "I am on X, Y or Z" as though it was the most natural thing in the world. The long-term use of those drugs horrified me even before we reached our present point of knowledge about them. We shall have to give urgent attention to that problem. It is easier to give urgent attention to something that directly threatens life, but emergency treatment should be available for those other ailments or stress-related diseases that do not necessary kill but cause many problems.
It is clear that many women suffer stress simply as a result of trying to perform the traditional tasks of being a housewife and mother while holding down a full or part-time job. I know that one suggestion to tackle the problem is the all-embracing creche facilities, nursery classes and the like. I am not against those facilities and I am sure that they have a valuable role to play. A futher solution that could run alongside those facilities, which would ease that burden, would be if women could take time off when their families were young without their employment and promotion prospects being impeded when they return to the market place. We must look far more closely than we have previously at the possibility of returning women to work after a period away from their working environment while they give their first attention to their families.
That may be the prerogative of other Departments, such as the Department of Employment, but I am sure it would not be beyond the powers of my hon. Friend the Minister to interfere, in the kindest possible way, in the activities of other Departments to ensure that they consider the woman's point of view.
It would be useful if medical practitioners and nurses were more aware of how much of a burden women carry


in their domestic lives and jobs. I know that it is generally believed that the husband or partner give far more help with the housework than they used to, but my strong hunch is that for every man who does all those saintly duties there are a further nine who do precious little, continue in exactly the way that they always have but expect the women to hold down a job and carry out the domestic duties.

Ms. Richardson: I follow the hon. Lady's argument—and I apologise for being absent from the Chamber for a few minutes—but does she agree that the introduction of the concept of parental leave, whereby both partners would statutorily be allowed to take time off work, would encourage more men to take more interest and responsibility in home care?

Miss Fookes: The theory is good, but what worries me is that it might lead to one more visit to a darts, football or snooker match rather than doing what they should be while on parental leave. Having reached middle life, perhaps I am becoming slightly cynical. In theory, the concept of equal responsibility is all very well. I should like to be proved wrong and find that they might not use the opportunity for something other than for which it was intended.
As a former teacher, I am well aware of the importance of catching people young. It is important not only to have education processes and campaigns for adults but to ensure that those matters are dealt with at school. I know that teachers complain that they are always being asked to add a further item to the overloaded curriculum, but it could be subsumed, if the information were given, in the various subjects by which health education is taught.
I am particularly perturbed about the number of young girls who smoke cigarettes. It is much more difficult to give up the habit than never to start it. I have never smoked a cigarette, but those who do must feel that they are part of a highly threatened minority that is hardly allowed to exist. Even hardened smokers would probably agree, however, that it would be better if youngsters never started to smoke. A much tougher programme is needed to persuade youngsters never to begin the habit.
All the good reasons why young people should not start to smoke will not necessarily work. Young girls are most vulnerable about their appearance. They are usually deeply conscious of it. Health education must be related to how they look rather than to how they will feel or how health they will be in 20, 30, or 40 years' time. It is very easy to make a good case about never starting to smoke by relating it to their appearance.
Several Opposition Members have referred to the fact that women doctors ought to be available for those women who would prefer to see them. Some women are so diffident that they do not even make the point that they would prefer to see a woman doctor. For all those who say that they would prefer to see a woman doctor, I suspect that there are many more women who would greatly appreciate that facility but who would never voice it because they are accustomed to seeing male doctors. The most intimate details are frequently spoken about these days, but I am sure that the great majority of ordinary women are very reticent about doing so. They would find it far easier to talk to a sympathetic woman doctor whom they feel would instinctively understand what they are trying to say. However well intentioned male doctors may

be, that is how very many women feel. This is particularly important to women who belong to the ethnic minority groups. It is a deep part of the culture of Asian women that they do not allow a man other than their husband to see or touch them. That may be misguided, but we shall not overcome that cultural opposition overnight. In the meantime, those women deserve as much care as any other women. They deserve the best care that is available. I hope that my hon. friend will look carefully at that aspect.
I am tempted to make a number of further points but I am aware that other hon. Members are anxious to speak in the debate. I hope that the few points that I have referred to will have made my hon. Friend the Minister aware of the fact that, although she has made an excellent start in dealing with the health of women, a great deal more remains to be done.

Mr. Ronnie Fearn: Despite what was said earlier, I am not in the least embarrassed about being here this morning. Male Members of Parliament have wives and daughters and we speak to one another about these matters. Our constituents occasionally talk to us about them. I am pleased, therefore, to have this opportunity to join in the debate on women's health.
Due to the structure of our society, women play a central role in the health of the nation. They are in a position to influence the health of others and to promote good and preventive health habits in our children. They are the major carers through their role in the Health Service and in the family and the community. That is one reason why their health should be of prime importance to the Government and to this House.
Today, more than ever, women are expected to cope with a diversity of roles, with little or no support. More women work today than ever before—some out of choice, others because of the pressures of a materialistic and consumer society, and many out of pure need. Most are in low paid and low satisfaction work. Few are in positions of power or influence. At the same time we expect them to provide a good family life and to care for our children, the sick and the elderly.
In the poorer sections of the community, these pressures are added to by intolerable housing and living conditions. We hear a lot about Victorian values. In many respects this Government have reintroduced Victorian legislation for the social services and the welfare state. However, it is time that we recognised that the structure of society is not what it was. Gone is the extended family and the close-knit community that could offer help and relief from the pressures of caring for children, the sick and the elderly. Today our carers are often isolated and expected to cope on their own. I do not find it surprising that women suffer from the effects of stress, anxiety and depression. It is time that we cared for the carers.
With the emphasis on community care, it is important that we should replace the old network with a full range of community services. There should be adequate day care facilities, creches, mobile clinics, day centres, home helps and visits and short-term respite facilities. There should also be improved benefits to relieve the financial burden that is often placed on our carers. With an improvement in these services, it may be easier for men to take on the role of carers, thereby giving women the freedom of choice that they should have.
It is with some concern that I note that district health authorities are finding it necessary to close down their family planning clinics in budget-saving exercises. Family planning clinics offer a wider choice of contraceptives. The staff are often better trained in these matters than the general practitioner and can offer more time for consultations than the average GP. It has already been said twice that many women prefer to go to clinics. Quite often, it is the only opportunity that they have to be seen by a woman doctor. Family planning clinics have proved to be cost-effective and we should consider expanding, not diminishing their number.
I welcome the Under-Secretary of State's claim in a speech to the Royal College of Nursing on 19 May 1988 that the Government do not want health authorities to cut back on the provision of family planning clinics. While district authorities continue to suffer from a shortage of funds, the position is unlikely to improve.
We hear much from the Government about freedom of choice. Many of their policies are justified by that cry, yet the centralisation and rationalisation programme in the hospital service and the cuts due to the financial crisis have limited the choice for many women. For instance, it is often the maternity wings of hospitals that are hit. Expectant mothers find that the criterion of choice becomes not the services provided but how far and for how long they will have to travel to reach a hospital.
The centralised programme is sometimes justified by the claim that health authorities are providing centres of excellence, equipped with all the latest advances in technology and equipment. When that claim is applied to obstetrics, we are in danger of pressurising women into giving birth in unnatural clinical surroundings and, in the majority of cases, with unnecessary technical equipment. The Government are on record as saying that their aim is to encourage hospital births in order to reduce the mortality rate, yet there is no confirmed evidence to support the theory that the fall in the mortality rate is due to hospital confinements. Hospitals have a far higher rate of infection of the mother than have home births. There needs to be more scientific evaluation of present methods before we continue to pressure women into high-tech births.
The real choice for women will come when we view pregnancy and birth as the natural phenomena that they are. We should provide the maternity services that the World Health Organisation recommends. The expectant mother must be given the opportunity, in consultation with her doctor and midwife, to choose the birth that suits her best. Therefore, the number of midwives needs to be increased and after-care services expanded.
That latter point is particularly important, because, as a result of financial and staffing pressures, more and more women are being sent home 24 hours after giving birth. The latest information from the Royal College of Midwives is that, between 1979 and 1987, the birth rate increased by a further 40,000 babies, but the claim that more midwives are being employed could be challenged and the Royal College of Midwives says that we are talking about only half a midwife per unit per week.
Later in life, many women have to suffer the effects of the menopause without any hope of alleviation of the symptoms of menopause-related diseases such as

osteoporosis, which is connected with the death of many older women. In June 1986, the Nursing Times and Nursing Mirror estimated that osteoperosis treatment was costing the Health Service £2 million per week, with a third of hospital beds occupied by women suffering from related ailments. We have heard with interest about hormone replacement therapy, which may offer women a better quality of life. However, before it becomes commonplace, there should be a further investigation of the short and long-term effects of such treatments, and more information and training should be given in methods of prescribing it.
The current financial crisis and long waiting lists mean that many women needlessly suffer the pain and discomfort of osteoarthritis and other conditions. Yet we hear of more ward closures and of a doctor in Sheffield contributing a third of his salary to keep his specialist osteoporosis unit for another two months. In the majority of areas, provision is not good enough. In Southport, we are lucky: a new hospital is due to open at the end of the year, although there again, it is to replace outdated buildings.
Four major causes of death in women have been identified as coronary disease, lung cancer, breast cancer, and cervical cancer. The last two are specific to women and I welcome the Government's attempt to improve matters through screening programmes. However, those programmes will not be completely successful unless the Government also provide and fully fund the necessary back-up services. I note with concern that units that began their programmes in January are already having to close because of a shortage of scientific and laboratory staff. With increased emphasis on preventive screening and new laboratory techniques it is imperative that the Government tackle the problem by improving and funding pay awards and improving career structures in the service.
The mammography programme requires a better training scheme for radiologists to prevent unnecessary recalls, and possibly the employment of specialist teams to ensure that the correct diagnosis is made and the correct treatment given. Both screening programmes should involve more counselling and after-care services for women who are proved positive.
Perhaps most important of all, the hospital services must be given the means to provide the treatment necessary. There is little point in introducing systems of early detection if treatment is thwarted by lack of equipment, lack of staff, and long waiting lists. There is also a danger that in the current crisis, less serious gynaecological cases will be pushed further down the list, with the result that more women will suffer months, if not years, of ill health, perhaps with more serious consequences.
The Governnment must look at the whole picture. Women play a pivotal role in our society. In an ideal world, men would share that role, but until the structures of our society are changed to accommodate that, it is especially important that women are given the local, community and work-based services that they require to meet the demands that society and Government place on them. The better health that women enjoy, the more benefit will accrue to us all.

Mr. John Browne: I declare an interest as a director of the Churchill Clinic, which is in the private sector. I very much welcome this first Government debate on women's health. The Minister, the hon. Member for Barking (Ms. Richardson) and others have alluded to the fact that not only is our total Health Service of vital national importance but it affects women more than men both because they live longer and because they have special roles such as childbirth, child care, and so on. They also have the role of educating children. As I hope to illustrate, preventive medicine is a key aspect. The debate is particularly timely and I am glad to have the opportunity to speak in it.
The National Health Service is about 40 years old and it is in a crisis of change. It has been alleged that the Government do not care and that they have instituted cuts. I find such allegations amazing. When I read Government statements or listen to Ministers, as I have over the past nine years, I find it hard to see how allegations of not caring could be justified. One type of caring is to give money away; the other is to ensure that that money is properly spent and that it genuinely goes to those who need it. That is effective care.
Let me deal with the allegation of cuts. Spending on the Health Service increased from £7.5 billion in 1979 to £22 billion this year. That is an amazing increase—30 per cent. and more ahead of inflation. Opposition Members' claims are therefore difficult to substantiate.
It is interesting to note that as more money has been spent on the National Health Service in vast amounts, so the complaints have increased. The complaints reached a crescendo last winter, which makes it obvious to me that the problem is not one of money and that we need to look somewhere else for the cause. Therefore, I greatly admired the Government's courage in not responding to the crescendo of complaint by pouring more money into what is effectively a leaking bucket. Instead, they decided to spend on a maintenance basis and conduct a top-level review to establish, on behalf of every citizen in the country, where the taxpayers' money must go to ensure that in the next 40 years the Health Service will still work, and work to the benefit of the nation as a whole.
As we all know, health is a complex problem. As has been said by the Minister and others, more people live for longer. As they live longer, more complex demands are placed on the Health Service. Furthermore, expectations have changed. When I was a lad, for the symptoms of many ailments one readily accepted a glass of hot milk and two aspirins and the recommendation that one should go to bed. Today people expect more sophisticated treatment, or at least more sophisticated consultation, for the same symptoms.
Technology has improved, and that is greatly to our advantage. But that has happened at a price far in excess of inflation. There is a technology expenditure curve, in addition to an inflation curve. Furthermore, high technology operations place much greater demands on the resources of the Health Service.
Technology has enabled operations such as kidney transplants, which were unheard of 30 or even 20 years ago, to become routine. They are very demanding on Health Service resources and there are huge opportunity costs. If kidney transplants are to be carried out, what operations will need to be stopped? What is the

opportunity cost? There is also a greatly increased awareness of new types of disease such as stress, which has already been mentioned this morning. That all leads to increased demands on the Health Service.
Somewhat misguided comments have been made today about alcoholism and so on being directly related to unemployment. My county of Hampshire has recently been told that it has the worst record in the country for violence against the police. There were 34 cases last year, 90 per cent. of which were alcohol-related. Yet Hampshire is not an area of high unemployment—indeed, it has low unemployment and high earnings per head. Therefore, we cannot simply and justifiably relate stress to high unemployment.
The good health of the nation is absolutely essential to our survival as a developed nation. However, it is not just a question of money—although funding is, of course, a critical problem. I hope that, in their current top-level review the Government will turn heavily towards preventive medicine. I apologise to my hon. Friend the Minister for not having given her notice, but I would be interested to know how much of the NHS budget is spent on preventive medicine. Even without knowing the figure, I guess that it is not enough. In that top-level review, preventive medicine must be seen as a massive source of cost saving. Government spending on preventive medicine should be seen as an investment in the future to reduce potential costs and claims on the NHS. Just as with buildings, to modernise, maintain and take preventive action is a good philosophy.
I support the Government's aim of increasing the emphasis on self-reliance, and women can play an influential and important role in that. However, the Government must also play a key role in preventive medicine. First, they must regulate on matters such as pollution. Secondly, they must provide preventive services such as screening, and thirdly, they must publicise much more widely the good programmes that they are following, such as immunisation, and educate on such matters as diet.
I know that my hon. Friend the Minister has done a tremendous amount in that area and I much admire her courage in challenging even the sanctity of the English breakfast and other dishes that are thought to be sacred. That took guts. She had to take a great deal of flak following some of her comments. The Government's first role in preventive medicine should include action on pollution, especially passive smoking and leaded petrol. Secondly, there should be action on what I call lifestyle—diet, alcohol and active smoking. The third area is in services such as immunisation and screening.
The recent Froggatt report shows conclusively that passive smoking alone—and I am not yet speaking of active smoking—increases the incidence of lung cancer by between 10 and 30 per cent. That is an enormous figure. Think of how many people are suffering and using the resources of the Health Service because of lung cancer predominantly caused by smoking.
When I spoke in the Chamber on 9 May 1980 (luring a smoking and health debate, I said:
I believe that the Government should consider legislation on non-smoking areas, particularly enclosed, confined public spaces, such as lifts, cinemas, waiting rooms and, indeed, the Committee Rooms and Dining Room of this House—a place where we are fortunate to have a specific Smoking Room set aside."—[Official Report, 9 May 1980; Vol. 984, c. 714.]


I was almost laughed out of the Chamber for saying that. I am glad to say that, today, I think the story would be very different. Indeed, there is now an early-day motion along those lines.
Subsequent early-day motions have stated that we should not have such a tyranny of restricting smoking.
The Government must take strong action. Obviously,people have a right to smoke—I am not trying to take away that right—but the Government's duty is to defend a far more basic right than the right to smoke, and that is the right of the non smoker to breathe fresh air. The Government have not grasped that nettle firmly enough. Leaving it to the free market is not enough. Every day people are unnecessarily being caused mortal injury. More legislative action should be taken, and the voluntary codes and so on should be toughened up. I realise that the Government believe in the free market, but legislation can hasten the free market. We have seen that done in many areas.
I now refer to leaded petrol. As we know, there are approximately 18 million cars in the United Kingdom. Two million motor cars, without any adaptation, could use unleaded petrol. Another 7 million cars, with the smallest adjustment to their ignition timing, could immediately take unleaded petrol. In fact, as a demonstration, James Bond's Aston-Martin was converted in 25 seconds. It is not an expensive deal. Most garages could do it for free. If they charged £1, they would get a lot of money for it. So, today nine million cars or 50 per cent. of the cars on our roads—could run on unleaded fuel. Actually, the consumption of unleaded petrol, despite the fact that it is 6p a gallon cheaper than leaded petrol—thanks to the Chancellor—is less than I per cent. of petrol sales in this country. Again, the Government must invest more money in publicity to put the message across.
I now refer to what I call lifestyle—food, alcohol and tobacco. Cholesterol and calorie intake has been proved of great significance and importance to health. The Minister has done a tremendous job in highlighting that. I am pleased to hear about the new consultancy on breast feeding. Breast feeding and early feeding habits of children are an aspect of foods. That is why women's role is so important. Breast feeding can affect people's metabolism for the rest of their lives. They become fat-inclined or not fat-inclined, sweet-toothed or not sweet-toothed, and so on. Such matters must be drummed home and money must be spent in terms of investment by the Government. Much more publicity is needed about diet. In terms of legislation, the Government should demand that calorie and cholesterol contents should be printed on food packages at point of sale.
In terms of alcohol—you will be shocked, Mr. Deputy Speaker, by the statistics that I hope to give—750,000 Britons are seriously ill as a result of alcohol abuse. That means that 2 million or more families are affected. Alcohol abuse is the United Kingdom's third most dangerous disease. Women are particularly prone to the harm of excessive alcohol intake, especially in the 25 to 37 age group. Excessive drinking was involved in 80 per cent. of deaths by fire, 40 per cent. of pedestrian traffic accidents, 33 per cent. of child abuse cases, 50 per cent. of murders, 30 per cent. of non-traffic accident deaths, and 33 per cent. of domestic accidents.
As I have said already, I am ashamed that, in Hampshire, we have experienced the worst rise in violence against the police. It occurs throughout the country, and it is rising at an alarming degree. Ninety per cent. of such offences are related to alcohol.
In the past 20 years, alcohol consumption has doubled, not declined. In 1982, £12·3 billion was spent on alcohol. No less than 38p of every leisure pound is spent on alcohol. That is more than is spent on food, light, newspapers, cigarettes, books or holidays. Alcohol has a high human cost—it is responsible for between 5,000 and 10,000 premature deaths each year, and for more than one in five patients being in NHS care. The monetary cost of alcohol misuse is estimated to be more than £1 billion in lost production and more than £1·7 billion in social costs.
The cost is huge. The Government have a duty to publicise that fact far more effectively. We have hard-hitting campaigns, which I support, on AIDS, for example, but the campaign on alcohol is nowhere near hard-hitting enough. Not enough money is spent on it. Will the Government seriously consider demanding through legislation that a health warning be printed on each bottle of alcohol? A label could be affixed, just as a duty-free label is attached. That would not be too expensive and it could be done quickly.

Mrs. Wise: Does the hon. Gentleman agree that it would be cheaper for the public purse if we restricted the amount of money spent by alcohol producers on promoting their products? If we did that, we might not need to spend public money combating their advertising.

Mr. Browne: I have some sympathy with that line, but I am more of a free marketeer than the hon. Lady. There are methods other than restricting producers, which I shall describe later. I believe that we should go for the advertisers and prohibit what can be advertised. That would have an immediate effect on what is spent on advertising.
The active smoking of tobacco is a major cause of lung cancer, heart disease and cervical cancer. It is estimated that smoking costs the NHS £500 million a year and that it causes more than 300 deaths a day. We have had pretty good results since 1979. Deaths from lung cancer have declined by 9 per cent., but among women have risen by more than 20 per cent. especially among women in their 20s. Girls aged between 11 and 15 now smoke nearly twice as much as boys of the same age. Smoking is a killer. I support the Government health warnings, but they are not enough. They are not hard-hitting enough. The Government must spend a lot more money to publicise the dangers of smoking. Alcohol and tobacco are killers and they require legislative action.
I am a director of a satellite television company. We have a self-denying ordinance—we will not accept any advertising of tobacco or alcohol products. That has an opportunity cost for us. We do it as a self-initiative, but I believe that the Government should prohibit advertising of tobacco and alcohol products on television, which is such an influential medium.
The Government have done a tremendous job on immunisation. The figures speak for themselves. There is now a 68 per cent. take-up of the vaccination for whooping cough, whereas it was only 31 per cent. in 1978, and there is now a 71 per cent. take-up of the measles vaccination, whereas it was only 48 per cent. in 1978. There is more to


be done, however, and I welcome the introduction this October of the combined, measles, mumps and rubella vaccination. This is probably the biggest change for 20 years. However, when I look at the grant of £48,000 that the Government have given to the Rubella Council, I think that that illustrates the problem. When one looks at the cost to the National Health Service of £22 billion, the £48,000 shrinks into an insignificance that it does not deserve.
On the subject of screening, particularly for cancer of the cervix and breast, we know that early detection is critical in successfully treating many of these cancers. We have about 2,000 deaths a year from cervical cancer. The screening that has already been carried out is estimated to have saved about 14 per cent. of those under threat. However, the new five-year screening programme that my hon. Friend has announced is estimated to save 84 per cent. of those who are screened. It is, therefore, a very laudable scheme that has been introduced. It is the first fully comprehensive programme in the world. I believe that the Government should be praised for taking this initiative last February particularly by extending the programme to cover women from 20 years of age. I wholly support that. It is all good stuff. Obviously, as it is a trendsetter for the world, we can expect problems, because we are on the cutting edge.
I have to say—my hon. Friend has already mentioned it in her speech—that we have a problem in Winchester and in Basingstoke, because our district health authorities are situated in areas where competing earnings are very high, the cost of housing is very high, and the payment given to those laboratory technicians—people with two A-levels and six months' training—of £7,000 a year is not enough. They are not striking, as they would have done several years ago, but they are getting on their bikes and moving to other employment and to other agencies. Therefore, what has happened is that Winchester and Basingstoke health authorities do not have the laboratory technicians sufficient to support this excellent initiative. Something has to be done, because women in my constituency are now being re-exposed to the risks that existed before the Government took those initiatives. As my hon. Friend has said, I believe that there are 75 per cent. of other laboratories that are under-utilised. The problem is that Winchester local health authority does not know this. It does not know which those under-utilised health authorities are, so how can it send its smears to them?

Mrs. Currie: It does now.

Mr. Browne: My hon. Friend says that it does now, and I am very pleased to hear that. One alternative is to send them into the private sector.
The other idea I must mention to my hon. Friend is that of local pay premiums. Our problem is only the tip of the iceberg. There are people on the clerical staff in our family practitioner units, starting as VDU operators, who earn £4,200 a year; while British Telecom in the same area pay £6,000 a year; local government £5,500; and the Civil Service £6,000. Effectively, the FPC is becoming a training ground for other people. They train and then move on to higher salaries.
The Government have to look at the private sector, for examples. In the private sector, I understand that in Winchester the National Westminster bank, after someone

has been on probation for four months, pay a £750 a year premium on their salary. I believe that the Government have to look at this in terms of the National Health Service and regional pay. As a result, Hampshire FPC is short of 25 people from a staff of 115. It is just under 25 per cent. understaffed. Unless this is sorted out, the system will collapse. It is an excellent system and highly efficient. The administrative charges are less than 1 per cent.
Our FPC is a very effective system and yet it is in danger of collapsing because of the low pay of certain of the staff. I think that the Government must examine it and consider stopping capital spending, maybe for a year, in order to put these wages right. They must regrade staff and pay regional cost-of-living premiums. As I have said, if it is not put right there will be a collapse of the cervical screening system let alone the breast screening system that we hope is to come. It will just not get off the ground unless collective action is taken.
To close, I believe that preventive medicine is absolutely essential. It is very cost-effective. The Government must legislate on smoking in enclosed public places. They must legislate on alcohol to get a health warning on bottles. They must legislate to curb advertising of alcoholic and tobacco products, particularly on television. I think that they also must also ensure that there is legislation to require that cholesterol and calorie values are printed on packs at point of sale.
As I have said many times, I think that the Goverment must spend much more on publicising both their own good works, such as immunisation and so on, and the whole concept of self-reliance and what people, particularly mothers, can do in this education process of preventive medicine. I know that the Minister, as I have said before, has already done a great job. I am sure that she will continue. She has shown great courage and I wish her good luck in this very challenging and exciting venture.

Several Hon. Members: rose——

Mr. Deputy Speaker (Sir Paul Dean): Order. I ask hon. Members to keep at least one eye on the clock. There are at least five hon. Members who have been in the Chamber throughout the debate who are hoping to contribute to it. I am sure that we would all be disappointed if they were unable to do so.

Ms. Hilary Armstrong: I have a train to catch, so I shall not be too long, Mr. Deputy Speaker.
I rise with some trepidation as a woman from the north, a category with which the Minister has not been too pleased. Women from the north have suffered some abuse of the past few years. I hope that the guilt that many women in the north have had laid upon them will not emerge in any way in my speech. I try not to behave in that way. As I have said, I rose with some trepidation.
One of the issues on which the Minister and I have corresponded on several occasions has been covered already in the debate, so I shall try to be brief about it. Cervical screening in my area is an issue that has been brought to my attention on numerous occasions. I have frequently found that the Minister's loose talk does not help. I ask her to examine again some of the reasons why


women suffer from this form of cancer. I ask her to take on board the fact that there is a reason to which she has not alluded.
The incidence of cervical cancer is not necessarily because women have a number of partners. There are women who have a partner with whom they sleep who has a job which is normally classified as dirty—in coalmining or the steel industry, for example. The incidence of cervical cancer in areas where these occupations predominate is higher than elsewhere in the country. I assure the Minister that I and others are convinced that that is the major reason for the incidence of cervical cancer in my area.
As there are no longer any coalmines or steelworks in my constituency, the world may begin to change. Women in my constituency have been working hard to organise and improve the services that are available, and it is not exactly helpful to tell them that they suffer for the reason that the Minister has given. That does not encourage them to continue to strive for better services.
I ask the Minister to examine the priority age for screening. There seems to be evidence that more attention should be paid to it for those in a younger age group. I accept what she has said about breast cancer screening, but I do not think that that is true of cervical cancer screening. What is the cost of putting work out to private clinics?
Last year I wrote to the Minister about a particular case. A friend of mine was screened in November and did not hear until the end of March that she had had a positive test. It is exactly a year ago this week—I remember it well, because it was the week of the general election—that she eventually had an appointment at the clinic to have her condition dealt with. It was well into August before she knew that she was clear. It is not enough just to stand here and say that that is appalling. The effect of that on women is devastating. My friend was a nurse, but that did not seem to help her. It was a devastating experience, and she was almost agoraphobic. She managed to continue to work, but little else. It has had a devastating effect on her confidence in having tests and on her future life.
I was interested in what the Minister said about the rate of screening and the Government's objectives. In 1986, we knew that 60 per cent. of women with cervical cancer had never been screened. We know that elsewhere there is an effective screening programme which reaches 80 per cent. of all eligible women. At that stage, we could not say what percentage of women was reached by our programme, and I should be interested to know what progress has been made on that
I was interested in the speech of the hon. Member for Winchester (Mr. Browne). He represents a town which in a league table drawn up by a local northern university is shown to be the most prosperous town in Britain. That same table puts Consett, a town in my constituency, at the bottom. The problems that the hon. Gentleman identified in recruiting medical laboratory scientific officers are exactly the same in my constituency. We have enormous problems, particularly because of salary scales, so they are not just created by success and a high wage economy. Consett is at the bottom of the league table because, despite new jobs, we are a low-wage economy. Even then, it is incredibly difficult to recruit MLSOs in the area.
In a recent letter, the chair of the Northern Regional health authority states of north-west Durham:

Latterly the service has been affected by staff illness and this resulted in a reporting delay of around ten weeks by the end of December 1987, but again by the use of a private laboratory that interval is now down to around six weeks.
He tells me that, in the other district health authority that covers my constituency, the same sort of problems exist.
I know, partly because I was chair of the union which recruits MLSOs, that the recruiting problem in both areas was acute, as was the difficulty of retaining them. They feel that they are not recognised as part of a health care team, that their work and contribution is devalued, and that that is reflected in their salary. Everyone who works in the Health Service has a vital role to play. To see the whole work force as a health care team is crucial if we are to get our preventive health care and responses right. Some health care workers feel not only that their contribution has been devalued, but that they are played off against workers whom the Government see as the hands-on, face-to-face workers. In fact, the contribution of the other workers is equally important. I am not saying that the work of nurses and doctors is not important; of course it is. Others, however, have a vital role to play, and we look to the Government to recognise that.
How do we enable and encourage more women to know, and be confident in, their health services? One of my local community health councils recently carried out a detailed survey, which found that the most disturbing fact about cancer screening was that some 27·6 per cent. of those tested were never informed of the results. The majority presumably assumed that no news was good news, but for some, as I have said, that was very much the wrong assumption.
The survey also discovered that many women did not know or feel confident about finding out when and where to go. Working with women's health projects in the Tyneside area, I found that they were largely able to overcome the problem, vitally affecting the number of self-referrals. The atmosphere and the campaigning nature of the clinics gave women confidence, as they knew that they could go along, meet some of their friends and be dealt with by a woman who would not only do a test but talk to them, listen to their problems and ensure that there was a comprehensive response.
Another group who have been to see me, and who are very distressed about what they see as a breakdown in the service, are the community nurses. Those in one patch of my constituency say that exactly the same number of staff as 10 years ago deal with a caseload 70 per cent. higher. Given that sort of increased pressure on community nurses and on those who try to provide a more holistic approach to health care, is it any wonder that women feel unsure about where to go and what to do? It is partly because they do not want to put additional stress on those whom they know are already overstretched.
Whatever label is attached to the service—well woman clinics, or community health care—I think that the Minister knows what we are talking about. I hope that she will work carefully to ensure that opportunities are provided, particularly in areas in which health care is especially important, because the figures show women to be at higher risk. Cuts in the number of well woman clinics, and the reduction in spending on health education, are not what I see as a positive commitment to support.
I should like to mention many other matters, but I shall be brief. The community nursing problem affects specific issues, which the Minister mentioned and which I had


meant to say something about—mental health. Community nurses have a crucial impact on that problem, and I hope that the Government will take it on. Let me also stress the importance of an effective occupational health service. There are now many more women at work; many more now have to work. There is clear evidence from Sheffield that an effective occupational health service improves not just attendance and sickness rates, but the general well-being of employees—and therefore I trust, that of employers. Moreover, it has increased productivity. The International Labour Organisation has suggested how specifically to encourage the development of a good occupational health service.
There are many other issues on the agenda and I believe that the Government know what they are. I press the Government not to lecture women about what they are not doing properly, but to ensure that women can meet their health worries and those of their families.
I remember when I spoke to one of the Minister's colleagues in the canteen downstairs. I noticed that he was having an extremely unhealthy lunch with lots of chips and other fried things. I said that a member of his Government would not be happy about that and he replied, "The trouble is that every time I hear her, it pushes me to have more chips." The Minister should learn from that. Lecturing people about what they should do frequently pushes them the other way.
The Government need to encourage and support good practices, and I accept that I must also do that. The Government must consider first how to give women positive support and encouragement rather than just lectures.

Mrs. Gillian Shephard: I am glad to have the opportunity to take part in this debate and equally glad that it is taking place in this Chamber, which focuses all too infrequently on matters of exclusive concern to women. I congratulate the Minister on initiating this debate.
I should like to focus—perhaps more narrowly than other hon. Members—upon the current issues of cancer screening and well woman clinics. I should also like to mention the traditionally included specialisms of maternity and family planning and broader issues that are of particular interest to those who are practically involved in Health Service work—the way in which services that benefit women are delivered and health promotion and education specifically geared to women.
Funding is not the most important element in the successful promotion of women's health, but the way in which available funds are used is important. I am concerned about the effect that local professional enthusiasm may have either positively or negatively on the way in which women's health is regarded.
There should be a combination of Government initiatives and good work at local level, which stems from the health authorities or family practitioner committees as well as the involvement of other relevant local statutory and voluntary agencies. Obviously women must accept that their health is as important as the health of their families and they must accept that responsibility. The private sector must be involved, but most importantly, there must be professional enthusiasm for the cause.
It is useful to consider what has been done by the Government to promote women's health. Obviously the Government can act not only by directly funding their own initiatives, but by pump-priming and initiating others' efforts. The most recent Government-funded initiative—it has had considerable airing this morning—has been the introduction of computerised call and recall systems for cervical cancer testing and the imminent introduction of mammography services. The introduction of the computerised cervical cancer testing system cost £10 million and involved an enormous amount of effort by Health Service staff to computerise many millions of manual records. When we last discussed the system during the passage of the Health and Medicines Bill, some hon. Members, notably Opposition Members, expressed their concern about the way in which the scheme was falling short. To redress the balance, I should like to illustrate the successful way in which that system is operating to serve the health authorities of my constituency.
In the area served by the Norfolk family practitioner committee as a whole, we had our computerised system of call and recall up and running by September, seven months before the Government deadline. The West Norfolk and Wisbech health authority has since January had a system of recall every three years for all women between the ages of 18 and 66, and of call every three years for all women between 35 and 66. The laboratory turn around is four weeks.
The Norwich health authority also serves part of north-west Norfolk, and its recall operates for women between the ages of 20 and 34 every three years. For women between the ages of 35 and 66, it operates every five years, and the call operates for women between 35 and 66 every five years. The laboratory turn around is just over four weeks despite the enormous increase in the amount of work with which the laboratories have had to deal.
While these authorities offer three-year periods of call, they are correctly concentrating their major efforts on getting an increased response to first-time call-out which in East Anglia as a whole is presently 40 per cent. That is not yet good enough, but there is a very good proportion of older women.

Ms. Ruddock: We all applaud the situation that the hon. Lady is outlining. The health authority in my area has been able to get that kind of system going. But a problem arises after the first laboratory turn around time of four weeks when there is an abnormal smear recording and women have to return. There are then enormous delays. Women have an abnormal smear and do not know what is wrong. That is because of the lack of colposcopy services. Perhaps the hon. Lady will tell the House about the colposcopy service in her health authority.

Mrs. Shephard: I shall he delighted to do that. In the West Norfolk and Wisbech health authority there is no problem. There has been some delay in the Norwich health authority but a colposcopy service is being instituted with the help of the voluntary sector. That will be instituted shortly in the Norwich health authority and that will reduce the problem. The problem is nothing like as extreme as that which the hon. Member for Lewisham, Deptford (Ms. Ruddock) described in her health authority.
These health districts have responded very positively to Government plans for mammography. The West Norfolk


and Wisbech health authority is not the best known in the world, but since January it has been providing a mammography service for women between 50 and 64 on four evenings a week and on Saturday mornings. It is on a self-referral basis and geared to suit the hours when women are free to go along. Since January, 500 women have been examined and in some cases that has resulted in the saving of life.
The Government can be involved in ways other than the funding initiatives of which I have given examples. Sometimes they can achieve as much by pump-priming, an example of which was the £100,000 announced at the start of European Cancer Week. That will clearly help women's health causes in the broader sense. Sometimes Government can help by encouraging effort by others. An interesting example of this approach was described by the Minister in connection with the breast-feeding initiative. The Government deserve to be congratulated on bringing forward cancer screening. That has put the United Kingdom ahead of the rest of our European partners. The Government are also to be congratulated on taking the whole issue seriously and for raising the national consciousness about it.
As important as Government initiatives is the degree of professional enthusiasm for the cause at local level. There is no advantage in the Government insisting that women's health is important if those running local health services do not agree and do nothing about it. I am struck by the contrast between the achievements of the two health authorities that I have mentioned, which serve my constituency, and the problems described during the passage of the Health and Medicines Bill. Although East Anglia is a RAWP receiving region, it is still several percentage points below its full allocation.
I hope that no hon. Member will suggest that south-west Norfolk is somehow part of the palmy middle class south-eastern part of the United Kingdom, because it certainly is not. As well as the problems of sparsity of rural services that are costly to run, parts of it are submerged by water for three months of the year, which makes the delivery of services a challenge that is not commonly met elsewhere—I suggest not in inner cities.
The reason for west Norfolk's success is that for some years there has been a ready acceptance at professional level—at doctors' level—that women's health is important. A well woman clinic has been running at two centres in my constituency for years. When cancer-screening services were introduced, the professionals led the way, the Government provided the money and the political and administrative will followed.
When we tried to introduce a well woman clinic in Norwich, we met with less success. There is one there now, but there was resistance from the serried ranks of male GPs, backed up by male consultants, all of whom said plaintively, "If a woman has something to say, surely she can say it to me. I am always sympathetic." That encapsulates one of the problems with women's health. It is vital that there should be professional enthusiasm and commitment to the cause.
It is important that all professional and voluntary bodies should be involved when a cancer-screening initiative is launched. Any local initiative must reach women more effectively through GPs and dental surgeries,

health centres, hospitals, schools, playgroups, voluntary organisations, women's organisations and the private sector than any national campaign, however well organised it is. Women need to know that the service is available, free and painless. An envelope dropping on to a doormat, backed up by extensive local publicity and all the relevant agencies, must be the right way forward.
I mentioned earlier the broader issue of the delivery of services, which in a rural area is vital. The Norwich health district has an excellent scheme of community care groups, which involves a range of health professionals attached to doctors' surgeries or groups of surgeries. Early incidence of forms of mental health that affect women, such as post-natal depression, is picked up by a range of health professionals.
Mention was made of carers, almost uniquely a women's group. Recently, one of our community care groups decided that more emphasis needed to be placed on the services available for carers. A meeting was arranged by the health educator. She involved the local youth and community services and provided a sitting service so that carers could attend the meeting. The Women's Royal Voluntary Service organised the transport and, as the meeting was held in a school, the local parent-teacher association provided refreshment. Information was given by the DHSS, voluntary organisations and Health Service staff. We must have such team work if we are effectively to deliver those services to women where it matters—close to their homes.
Much importance must be attached to the local promotion of cancer-screening services. If health education is to run effectively, it must involve all agencies and, where appropriate, the private sector. Large companies such as Tesco and Sainsbury concentrate on healthy lifestyles.
Health education is almost more important for women than men. Clearly, the advice that is taken on board by women is absorbed for the benefit of their families. In that regard, I am glad that the producer of a certain sunflower margarine has withdrawn the suggestion, which it extensively promoted in a former advertising campaign, that it was more important to keep one's man healthy than oneself. I note that Flora is now thought to be good for everyone, not just for men.
For the information of the hon. Member for Barking (Ms. Richardson), I live in Lambeth. I have no problem in obtaining cheap, healthy food at my local Sainsbury, Tesco or Bejam. Local competition provides a wonderful baked bean that is much cheaper than I can find in Downham Market.
The promotion of women's health is a team job. The Government have their part to play. The Government have done just that in many vital areas, but if their policies are to be translated into effective action there must be local professional conviction, local action, local promotion, local involvement of all agencies in both the private and the voluntary sector and acceptance by the individual woman that her health is her responsibility.

Mr. John Hughes: I am most grateful for this opportunity to contribute to the debate. Having had to wait to speak for so long, I feel that I am suffering from what could accurately be diagnosed as "manopause."
Due to the effect of Government policies, there exists what I would describe as a Dorian Gray health service. Its looks bear little reality to health in general and to the many specialist areas of health care that are so important to women—none more so than primary care in the home.
It is a fact that all the knowledge gained from many health surveys has established that in areas of deprivation where there is high unemployment the physical and mental health of families is considerably worse than that of families in employment. Until recently, however, direct evidence that unemployment causes poorer health was not available. There is now substantial evidence that unemployment causes a deterioration in both physical and mental health.
Although the well-established pattern of women having lower death rates than men but experiencing higher sickness rates still holds true, recent studies have shown that the position is far more complex. Women's health varies according to social class, employment and marital status in ways that are only just beginning to be understood. The health of working-class women is particularly poor.
Striking regional disparities in health can still be observed. What is becoming increasingly clear from fresh evidence are the great inequalities that exist between communities living side by side in the same region. Numerous studies at local authority ward level have pinpointed pockets of poor health that correspond to areas of social and material deprivation. Alongside them, areas with much better health profiles can be detected and they exhibit more affluent characteristics.

Ms. Mildred Gordon: My hon. Friend might like to know that in 1986 the key population and vital statistics of local authority and health authority areas showed that women married to men in the manual socio-economic category suffered from three times as much chronic sickness as the wives of men who are classified as professionals. I represent part of Tower Hamlets, one of the most deprived areas in the country. It has the highest morbidity rate in London. The morbidity rate is inversely related to socio-economic groups, so I could not agree more with what my hon. Friend has said.

Mr. Hughes: I thank my hon. Friend for that contribution and I hope that the Minister will note it.
The differential is also to be found in other groupings. Although there has been a fall in all-cause death rates in Britain, the improvements in health have not been experienced equally by all sections of the population. Non-manual groups have experienced a much greater decline in death rates than manual groups. Thus, the gap between the two groups has widened. Futhermore, the number of deaths from coronary heart disease and lung cancer has increased alarmingly in the manual groups, whereas there has been a substantial decline in the number of such deaths in non-manual groups. There is also a widening gap between rates of chronic sickness in the manual and non-manual groups.
In our society of abundant poverty, those are the inequalities of health that apply to the deprived areas of Coventry, such as Willenhall, Stoke Aldermoor, Wood End and Foleshill, which have higher mortality rates and more ill health than other areas. The provision of health care, which comes under the jurisdiction of Lady Butterworth, the chairperson of the Coventry family

practitioner committee, fails to take that background into consideration. Instead, Lady Butterworth allocates the same number of deputising calls to each practice in Coventry. She makes no allowance for social class or the health status of the patients in a practice. In the process, she exacerbates the inequalities of health, to the detriment of young mothers with children and old women who require practitioner services.
During her period in office, Lady Butterworth has refused permanently to allocate an extra allowance for the deputising service to practices located in the areas that I have mentioned. That leaves doctors with two choices: they can dispense more prescriptions, which would result in a worsening service for women in deprived areas at even higher cost to the taxpayer, or they can caringly and humanely respond to calls above their allocation and find themselves subjected to the most detailed investigation. The doctors in one practice had to explain their actions over a period of 365 days.
With iron-fisted rigidity, Lady Butterworth applies the most draconian measures when a little understanding and a small amount of extra allowance—the cost of which would be far less than the cost of extra prescriptions—would result in better care for women. She refuses to recognise that women suffer from major illnesses and require visits from the doctor more frequently outside normal hours than is provided for in the average allowance. In women's interests, she is obliged to ensure that such visits are available. In other parts of the country such miserly allocation has led to general practitioners who realise that they cannot win applying to opt out of night and weekend work and to forgo the related fees. That is to the detriment of women and I am determined that that will not happen in Coventry.
I feel that it would be in the interests of the well-being of women patients in Coventry if a new chairperson were appointed to the Coventry family practitioner committee, as the present chair has failed to fulfil her duties in many ways. She has allowed money obtained by fraud, which should have been used for the well-being of women in the deprived areas of Coventry, to be retained by a practitioner. She has allowed a single-practice doctor, who claimed a partnership allowance, attracting a higher payment entitlement, fraudulently to retain £42,000, and so failed to imitate the exemplary chairmanship of her predecessor, who recovered £19,000 in similar circumstances. Fraud appears to be condoned when a chairperson of the FPC refuses to carry out the instructions of the committee by suggesting that the matter be buried and when no attempt is made to recover the money. The case was covered up and the police were not informed.
This culpable default of duty also applies in the case where a GP is allowed to retain a fortnight's income when that GP, against the interests of his women patients and in complete breach of his contract, disappeared for two weeks' holiday.
The circumstances in Coventry require immediate investigation. The present term of office of the chairperson should be instantly teminated if the chair has not the grace to resign in the meantime.
The attitude that prevailed impaired even my representations when I sought the assistance of the Minister because of the failure of the FPC to provide adequate and stable care for one of my chronically sick constituents, who had been shunted from doctor to doctor after being placed for only the minimum period. I am


certain that that is only the tip of the iceberg and that many more patients are being subjected to a process that is a contradiction of the ethos of the Hippocratic oath.
The circumstances in Coventry, to which I have drawn the attention of the House, are not unique—I am sure that they exist elsewhere. In the interests of women patients, there should be a committee of inquiry into the whole process of the FPC service so that we can eliminate the malpractice that has occurred in Coventry. In the interests of my constituents, I shall resubmit to the Minister the names of Coventry patients who are currently experiencing serious problems under the FPC service. I hope that that will enable her to resolve the problems with some urgency during her ministerial investigation.

Miss Emma Nicholson: Thank you for calling me to speak in this debate, Mr. Deputy Speaker. I am becoming a little worried about the health of the non-lady Members of the House who are not with us today. I am sure that they are grossly damaging their health with fatty lunches in pubs. I am sorry that they are not here to hear some very interesting speeches.
When I learnt of today's debate, I cancelled my constituency engagement with the Tavistock under-fives group this afternoon. The mothers asked me to raise a number of points on their behalf, but most of them have already been most capably raised by my hon. Friend the Member for Norfolk, South-West (Mrs. Shephard). However, one point that she did not raise—unless I missed it—is a crucial issue on which I intend to touch lightly, and that is the need for more women doctors. This is no sexist or feminist comment because it is of particular importance to the Moslem community.
Although I understand that the Koran does not literally forbid women to consult male doctors, by custom and habit many of the older women do not do that and their health is therefore significantly undermined. They may have potentially life-threatening conditions, that actually result in death, because they cannot consult a male doctor. Therefore, the provision of more women doctors is of acute importance to society.
The key to good health in our society lies in greater stress on preventive medicine. I want to talk a little about how preventive medicine is currently practised in the United Kingdom and how it could be improved. The most dramatic aspect of preventive medicine is immunisation, which can change the whole pattern of public health. It is, therefore, good news that the World Health Organisation has withdrawn its opposition to immunisation, which it once viewed as achievable only at the expense of building up the necessary infrastructures for health care.

Ms. Harman: I should not want this interesting debate to pass without some mention of the measles epidemic. Will the hon. Lady join me in urging everyone to take their children for immunisation, which is almost entirely without risk? I am glad to see the Minister nodding.

Miss Nicholson: I was intending to touch on that matter in a moment, but I am pleased to join my hon. Friend the Minister and the hon. Member for Peckham (Ms. Harman) in stressing the need for immunisation. In overseas countries, it is easier to spot the fact that the

measles virus has mutated into a killer disease. It is no longer just the few lumps and bumps that it might have been in our childhoods.
Smallpox immunisation was the first great example of successful vertical programme intervention. Worldwide eradication of smallpox—the great achievement of the World Health Organisation—has been completed and is a triumph.
The United Nations task force on child survival recently announced that it planned globally to eradicate polio, another of the great crippling and killing childhood diseases, by the year 2000. That is a great tribute to the International Rotary Polio Plus campaign, which was launched some years ago. It has taken the World Health Organisation a little time to agree that the eradication of polio can be conducted separately from, but while continuing, immunisation against the other five major childhood diseases.
I pay tribute to the Save the Children Fund Stop Polio campaign. Ten million pounds was raised and spent in the first four years of its existence alongside the Rotary Polio Plus campaign. That campaign has now been subsumed into the overall immunisation programme.
Polio is a major problem for developing countries. For example, in India, every year 200,000 children catch polio. Many more do so in Africa. In Malawi, when we ran the Stop Polio campaign for the Save the Children Fund, five or six years ago we achieved 90 per cent. coverage. By contrast, at that time in Lambeth, polio immunisation had a 37 per cent. take-up. The crucial importance of communicating with mothers and children simply cannot be overestimated. It is almost the most important factor after development of the vaccine.
It is marvellous that, at last, in this country we are starting by immunisation, the long haul to eliminate CSR—congenital syndrome rubella. We should think hard about the initiatives taken by the Royal Commonwealth Society for the Blind. We clearly appreciate the values of immunisation in developing countries, so perhaps we should apply them nearer home. As recently as 1982, the Royal Commonwealth Society for the Blind convened a conference to discuss rubella and its tragic and miserable consequences. The risk of pre-natal damage from rubella is highest in the first four months of pregnancy. If a woman catches rubella in the first month, her child may suffer multiple handicaps—deafness, blindness, and physical and mental handicaps.
About a fortnight ago I talked to a man in my constituency about the Abortion (Amendment) Bill. His mother caught rubella in about the fourth or fifth month of pregnancy. He has a weak heart, poor eyes, poor ears, and bad health. He said how much he would have wished not to be alive had his mother caught that illness earlier. That is an important point to remember.
I strongly welcome the 1 October introduction of the MMR vaccine—measles mumps and rubella. Measles is a wretched, mutative virus. I recognise the need to get rid of it as fast as we can. Of course, we are late in that respect, as so often we are late. MMR has been used in the United States of America for perhaps 20 years. In 1970 we started our anti-rubella programme for schoolgirls of 10 to 14 years, whom we saw as the vunerable age group. But the MMR vaccine will be given to 15-month-old babies. I understand that we seek a 90 per cent. uptake, which will


allow us to eliminate rubella in particular, and, I hope, measles and mumps. The booster pre-school package of diphtheria, tetanus and polio will include MMR.
It used to be said that one could not eliminate such contagious diseases and that smallpox was unique because it was carried only by humans. The great advantage of the polio immunisation programme was to counter that suggestion. Polio is carried by primates. It is a water-borne disease, and medical experts said for a long time that it was ineradicable because no sooner would it be eliminated in a group of human beings than they might catch it again from primates through the water supply. When immunisation is built up in children and babies, the human race seems able to deflect the disease. It is enormously encouraging, therefore, to see that genuine eradication of contagious diseases other than smallpox is a possibility.
I should like to pay a strong tribute, in regard to the measles, mumps and rubella vaccine, to the Rubella Council, which was formed as a result of the 1982 Royal Commonwealth Society for the Blind initiative. The council is chaired by Jean Wilson, who is the wife of the chairman of the Royal Commonwealth Society for the Blind. Like the council, I welcome the extra £40,000 a year grant, which brings its funding up to £83,000 a year.
I am sorry that my hon. Friend the Member for Winchester (Mr. Browne) has had to leave, because he would be interested to know that the funding is for promotional purposes, not for eradication. If the £35,000 that the council has been running on for the past five or six years is anything to go by. it will do a remarkable job with the additional £40,000. The funding is not to enable the council to immunise 15-month-old babies but to enable it to tell mothers and everyone else that 15-month-old babies need the new immunisation.
This is a good example of successful partnership between the Government and the voluntary sector. I welcome that in health care. I have participated in such partnership and I know that it works. With the Save the Children Fund, I participated in the anti-rickets campaign. We mistakenly thought that we had eliminated rickets from the United Kingdom many years ago, but without sufficient vitamin D people will still suffer from it. People with darker skins, particularly the Asian community, have a predisposition towards rickets if they live in Britain because there is considerably less sun here to enable them to synthesise vitamin D. People with darker skins need significantly more sun to achieve the synthesising effect.
We had to reach out to Asian mothers, through the Asian community, to teach them to bring their children forward for additional supplies of vitamin D. The mothers had rejected officialdom already and I suggest that the heavy hand of Government would not have had the same effect. The very best of the non-governmental organisations have a lighter touch, a more personal approach, a sharper eye for human needs and more flexible rules which enable them more swiftly to meet those needs. It is a matter not of the state not being able to provide everything, but that it should not provide everything, because non-governmental organisations can provide some services better than the state can. The quality and effectiveness of provision should be the determining factors.

Mrs. Wise: Does the hon. Lady agree that providing cheap or free welfare milk for infants made a considerable contribution to the elimination of rickets and that it is a great pity that that does not happen nowadays?

Miss Nicholson: I am not absolutely sure about the vitamin D content of milk as compared with the benefits of sunlight. It is certainly true that when we eliminated rickets in the United Kingdom, free milk was supplied. Vitamin D comes from other sources, too.
My point about the Asian community in the United Kingdom is that people with darker skin need more sun to synthesise vitamin D. Those of us who have paler skins are acclimatised to our miserable lack of sun, and we are therefore able to use the limited sunlight more effectively. Because of the miserable problems—such as fear of going out and worries about safety—of Asian mothers, they and their babies stay indoors, so they do not benefit even from the minimal sunlight that is available. Extra-rich vitamin D foods, suggestions on diet and more fresh air, and, of course, oils rich in vitamin D, cod liver oil and so on, are offered by the National Health Service. However, it was the outreach to that community which mattered most. That is where the valuable partnership between the voluntary organisation and the Government comes into play, with the Government providing virtually all the funds, and the work being done by a highly respected child care organisation, well known internationally.
I turn to one aspect of the care of the elderly, but only briefly, not because it is not important but because time is short. I feel justified in raising in a debate devoted to women and health the plight of blind women. Most of the constituency of the Royal National Institute for the Blind consists of elderly women with visual problems. Women are considerably healthier than men. They live longer, they are tougher when they are babies and in many ways we are luckier than men. However, because of our long life, more elderly women than men are blind or have sight problems. As everyone knows, only a third of those who have visual problems are registered. One hundred and forty-six thousand people are registered as being blind and 82,000 as being partially sighted.
Ophthalmic surgery has advanced so rapidly, with the new technology for the removal of cataracts—using laser beams and lens implants—that major surgery can now be undertaken for people who have cataracts and ocular degeneration in old age. However, it is expensive and is far down the Government's list of priorities. I suggest to my hon. Friend the Minister that more funding on this aspect of eye care would save money for the social services, apart from improving the quality of life of those who have their sight improved.
I welcome the recent announcement by the Minister for Social Security and the Disabled of a grant of £200,000 to the Royal National Institute for the Deaf, which is allowing fresh training provision to be undertaken by social workers who care for the deaf. That is an important element of work in our society, just as special training for social workers who care for the blind is important. That again is a partnership and an initiative involving a voluntary organisation and the Government.

Mrs. Audrey Wise: I appreciate the remarks that the hon. Member for Torridge and Devon, West (Miss Nicholson) made about the Asian community and voluntary organisations. I share her wish that 'voluntary organisations should be helped and encouraged in their work. In fact, it has been noticeable that during the lifetime of the present Government many voluntary


organisations have felt that they are being pushed into being a substitute for the Government rather than playing their proper role as partners and carrying out the kind of work which the hon. Lady correctly outlined, and which cannot be done simply through professional organisations or governmental bodies.
The debate has set the topic of women's health in context, both establishing the importance of good health to women and, as they are the majority of the population, to society in general. We need not justify our anxiety about our own health by reference to our partners or our children. We should defend our right to health in our own terms and for our own benefit.
Nevertheless, as women are the major planners of family diets and have responsibilities—some of them inescapable and some which should be more shared—for child care, they do have a special place in society. I associate myself with my hon. Friends who have set that in the context of poverty and have talked about the impact of bad housing and unemployment on health. It is impossible to consider ill health without considering the ills of society.
I associate myself also with my hon. Friends' remarks about the need for a cross-departmental approach. One of the distressing features of the British style of Government, and perhaps this it true of others—I am not singling out Britain but it is Britain that I observe at close quarters from day to day—is that policy appears to exist in little boxes. Governing in that way simply does not work properly, especially in matters concerning women. I associate myself entirely with the remarks of my hon. Friends on the importance of the Departments of Employment, Transport, and Energy in this context.
References have been made to food, and there has been some give and take about whether it is possible to buy cheap, healthy food as easily in working-class areas as elsewhere. I remind the House that the British Medical Association has established clearly that a healthy diet costs more than an unhealthy one because of the extra cost of supplying enough calories. The individual salad and vegetable items that go to make up a healthy diet may not be excessively priced individually, but it is necessary to provide more food of that sort to obtain enough calories. That should not be ignored. Cost is important, and studies have shown, for example, that it is impossible for expectant mothers on supplementary benefit to provide adequate diets for themselves and their coming babies. Not enough attention is given to these matters by the Government when they reduce the incomes of such mothers.
Even if someone has the money and the wish to eat a healthy diet, it can be well-nigh impossible to achieve it. For example, it is of doubtful benefit to eat lettuces in the winter because of their nitrate levels. A person may want to have good quality food and may have the money to buy it, yet still find it unavailable because of the distortion of agriculture policy. This arises for two main reasons. One is the pursuit of short-term profit and the second is the distortion and wrongful use of public subsidy for purposes that are connected with economic and agriculture objectives that are of less importance than the maintenance of health. The Ministry of Agriculture, Fisheries and Food has a great role to play in enabling the public to have a good diet, assuming that other

Departments play their part and we manage to achieve suitable incomes and obtain sufficient knowledge to enable us to want and have a healthy diet.
I associate myself with the remarks that have been made about the desirablility of well woman clinics or centres. In Preston we have a good, popular well woman centre in which women doctors, non-professional helpers and counsellors participate, but it is absolutely tiny so it cannot cope with the demand that exists just underneath the surface. It does great work with ethnic minorities. Its ethnic minority worker, who has splendid contact with the whole of the considerable ethnic minority community, goes out from the clinic and does valuable work in the community.
We do not necessarily need a bigger centre—smallness can be desirable in this sort of context—but we need more of them. This one exists only because Preston borough council helped to find it premises and the district health authority helped it with money, but not enough. That is an area where we can have good partnership between voluntary workers, ancillary health-related people and professionals, such as doctors and nurses. But there needs to be pump priming, and that is not happening, so we have an inadequate network of well woman clinics—enough to show how valuable they are, but not enough to tackle the problems. I recommend the Minister to give that genuine consideration and to take action.
Well women give birth to babies, and maternity is not an illness. I greatly regret that over the years women have been forced into large district general hospitals which are geared to the treatment of illness and have found themselves cared for by people who are accustomed to abnormality rather than normality. The present concept of childbirth is almost one of medical crisis. That is wrong and we need to move in the opposite direction.
I urge the Minister most strongly to look at the need for continuity of care for women who are pregnant, in childbirth and after childbirth. It is monstrous when a woman goes to an antenatal clinic and does everything that the authorities exhort her to do—going monthly, then fortnightly and then weekly—that every time she sees a different midwife or doctor, and sometimes several of them attending to different bits of her. That is dehumanising for the woman and deskilling for the carers. We have gone too far along the wrong road.
I endorse what has been said about the need to pay women, nurses, doctors, health visitors and midwives properly. That is a necessary prerequisite, but job satisfaction, self-respect for clinical judgment are also important. Midwives have an excellent training which equips them to be practitioners in their own right and not to be the mere handmaidens of doctors. They exercise clinical judgment and are experts in normal birth. But they are not being given an adequate opportunity to exercise their clinical judgment. That is why the Labour party's approach in its good document on women and health, which will stand the test of time, puts great stress on the approach to maternity, maternity services and the role of midwives.
It is wrong for women to be treated as a collection of little "patches", which are seen by different people on every visit. It is also wrong that they are given entirely inadequate choice about the place and style of giving birth. More and more women are entering the controversy and making more and more demands, and I should like the Minister to commit herself to choice.
We hear a great deal from the Government about choice. which often amounts to the choice between two indistinguishable products on the supermarket shelves. In this instance, however, choice is a genuinely important element, because women are different and have different needs and wishes. There is not only one good pattern or one simple recipe for a good birth experience and a good outcome. In this context, a good outcome does not merely mean that the baby does not die: that is obviously imperative. It also involves the opportunity for bonding, and a positive feeling that does not make a woman say—as so many say immediately after giving birth—"Never again." That is not conducive to the development of a good relationship and good child care.
The argument is not between high-tech and low-tech; that would be a stupid argument. It is a matter of appropriate technology and adequate choice, neither of which is at present available. Many women are subjected to far too much intervention when giving birth, and a much too lavish use of expensive technology which they do not want or need. Others are deprived of, for example, adequate anaesthesia when they need it, because anaesthetists are too scarce, and the one who is there is busy with someone else. That is a nonsense. We need appropriate technology, no unnecessary intrusion and respect for women's wishes—as well as an acknowledgement by all concerned that as women's bodies swell their brains do not shrink.
The position is now so serious that some midwives leave the service because they are unhappy with their conditions, while others are driven outside the NHS to practice independently so that they can provide continuity of care. That is not because they want to be outside the NHS, but because this approach to maternity care is becoming unavailable on the NHS. We should look carefully at this phenomenon.
We should also look at the effect on midwives' ability fo exercise their clinical judgement. I do not know whether the Minister is aware of the controversies that are currently raging, but they bear on this. One instance is the disciplining of a midwife who decided to transfer her patient to hospital and, instead of waiting for an ambulance, accompanied the patient in a car driven by the patient's husband. That midwife has been disciplined for not waiting for an ambulance, although she exercised her clinical judgement about what was suitable, and she was right. There was a good outcome.
I should like to know who would have been disciplined if the midwife had waited for the ambulance and it had not come—for ambulances are increasingly scarce—or if it had come and had therefore been unable to go to someone else. Such an approach to the exercise of a midwife's clinical judgment is absolute rubbish. I should also like to know who is disciplined if there is unnecessary and intrusive use in hospitals of techniques such as episiotomy, which often have a very bad effect on women. I urge the DHSS to investigate that very carefully.
I welcome the breast-feeding initiative and I applaud anything that is done to encourage it. Breast feeding is extremely important for both mother and baby. The more time that elapses, the more work is done and the more information published to strengthen the argument for it. It is not, however, simply a matter of lecturing women about its importance. One Conservative Member said that the importance of breast feeding had to be "drummed in" to women. I can think of nothing less effective than trying to

drum something in to women, although I hope that the hon. Member did not mean it in quite the way it sounded. Unfortunately, much of the health exhortation to women comes over in exactly that way: "Why can't you be a good little girl and do what is proper? Don't you care about your baby?" And such like. It is monstrous to behave in such a manner to women who are frequently suffering the greatest stress and pressure which is not being addressed by those who exhort them
I should like steps taken to prevent, not just to discourage—we are not talking about voluntary codes of practice—the promotion of baby milk formulas in hospitals and clinics. Such promotion still takes place and as long as the manufacturers of powdered milk have access to clinics and hospitals, mothers will be influenced to think that such products are the best for their babies.
Staff must have not only the right attitude, but enough time. That may mean that more staff should be available. Staff should not be harassed and, in their approach to hospital activities, they should not be made to believe that the efficient use of hospital resources means that they are kept almost at a run all day long while on duty. Staff should have the time to develop relationships with the women and observe them to see what can be done to make breast feeding the joy that it can be.
I also think that the Department should consider weaning. It is virtually impossible to obtain single weaning foods. Foods like "bacon and egg dinners" thrust at women as weaning foods. Any mother who has an eye to weaning her child sensibly, food by food, finds it difficult to get to first base even if she has the knowledge and income to do so. Something should be done and that means interfering with the free market economy. Such a free market economy often puts our infants second to money making, and that is highly undesirable.
During and after maternity women need back-up help, not just lectures. They need home helps, for example. If they have a home help after childbirth they should not be made to feel that some elderly person has therefore been deprived of such help. The squeeze on local government is having a deplorable effect on the availability of such help.
I urge the Minister to consider a submission from the National Childbirth Trust on infant mortality It has suggested a number of topics for investigation, ranging from excessive obstetric interference through to tie effect of poverty and bad housing on the increase in respiratory infection among babies, which can be an underlying feature in cot deaths. The National Childbirth Trust has a great deal of experience of mothers and babies and it pinpoints poverty and bad housing as being likely to have an effect on infant mortality. It believes that such factors should be investigated.
Another matter that should be considered is the danger of radiation. It is appropriate that this debate has taken place this week, after the information published about Dounreay.

Ms. Ruddock: I had hoped to be able to make a speech about environmental pollutants but I shall not get the opportunity. May I draw the attention of my hon. Friend and the Minister to early-day motion 1080? It is the only one on the Order Paper about women and health matters. It is a request to the Government to instruct the National Radiological Protection Board to investigate radiological standards. Current standards are based on the whole body male. We know, and scientific evidence shows, that for


women and children the risk from ionising radiation is much greater than the risk to men. The risk to the foetus in the womb is considerable and there is probable evidence that the tragic child leukaemia deaths from the Dounreay area may well have resulted from radiation affecting the foetus. Through my hon. Friend may I ask the Minister to look into this matter?

Mrs. Wise: I associate myself entirely with my hon. Friend's intervention. I shall not repeat it, but I reinforce it.
The hon. Member for Torridge and Devon, West said that women live longer than men. We are grateful for that, but it does not follow that the quality of life and health of most women is better than that of men. We are survivors, but women often survive against great odds and with greatly impaired health for many years. They suffer considerable stress and strain and physical ill health.
Simply living longer is not a good enough objective. We must achieve a better quality of health for women and it is not enough simply to say that we can stick a bandage on the Health Service or issue umpteen prescriptions for tranquilisers or tranquilise the whole population so that it does not see what happens to society. Sometimes I think that that is happening. We need an attitude to health that looks at the whole person in health care and medicine and not simply at isolated symptoms. As public policy we need to look at the whole of society. We need adequate preventive medicine for our society. I end as I began, by placing the matter of women's health care in the context of poverty and deprivation and the need for new priorities.

Dr. Charles Goodson-Wickes: I am glad to have been called to speak in the debate. While it may appear to be discourteous to make my contribution late in the day, I trust that the fact that I have been treating patients is an acceptable reason. That also registers my interest in the subject.
I think that this is the first general debate that we have had on women's health. Nowadays it seems fashionable to link women's interests to those of various minority groups. I speak as a member of a minority group—as a member of the male sex—and I have never quite understood the logic of that linkage. I certainly make no complaints and hope that with improvements in women's health care the present ratio and happy state of affairs will continue. Perhaps I could make a plea to my hon. Friend the Minister for a debate in due course on men's health or perhaps for a debate on some non-sexist subject such as geriatric health.
I am sure that the House approves of the unmistakable trend in the world of medicine towards prevention. The last century saw the first public health revolution and a reduction in the ravages of infectious diseases by means of better nutrition, cleaner water and air, and innoculation. We are now in the era of the second public health revolution and it is possible to educate people to reduce the risk of developing disease by modifying their behaviour and lifestyle. This is applicable in cardiovascular, respiratory and gastro-intestinal conditions and can be done without making life miserable.
When I became a medical student 24 years ago, teaching was virtually confined to the cure of disease. The notion of screening apparently healthy individuals was in

its infancy. Specific tests were introduced gradually for presymptomatic disease. In addition to the admirable work of the National Health Service, the private sector is to be congratulated on pioneering the general screening of individuals. For many years I have been active in that work and in the identification of occupational hazards to the health of male and female employees.
Screening for cancer of the cervix and breast will clearly attract most attention in any discussion of women's health. However important those aspects may be, they represent too narrow a view of women's health generally. The effectiveness of cervical smear testing, which has been available for more than 20 years, depends on technical efficiency. I was alarmed recently by reports of deficiencies in the taking of such tests, which often impede sound diagnosis by yielding false positive results, which alarm patients unduly, or false negatives, which create a false sense of security. The credibility of the test depends on the technique of taking it so as to ensure that the laboratory interpretation is valid. I cannot emphasise enough the input that there must be in teaching hospitals to ensure that medical students are adequately taught.
All such efforts are useless if those at risk do not come forward. For 20 years, Sutton and Merton health education unit has pioneered increasing awareness among the public and encouraged people to come forward through the National Health Service, voluntary organisations, industry and schools. Screening is flawed—perhaps fatally, in the true sense of the word—if the administration of recall is inadequate. I congratulate the Government on the steps that they have taken to computerise the recall system.
Breast cancer has, to an extent, been the poor relation in public awareness and resources allocation. That is curious because, on a per capita basis, more lives are saved at less cost. The incidence of mortality from breast cancer is far greater than that from cervical cancer, with 15,000 deaths per year at all ages as opposed to 2,000—a sevenfold difference, which the House would ignore at its peril. Those statistics show the way forward for the future, and I am delighted that St. Bartholomew's hospital has been active in implementing the recommendations of the Forrest report. I hope that the Government will be flexible and examine the results in relation to the right age bracket. We must bear in mind that if women have a family history of carcinoma of the breast they are far more at risk than others who have palpable findings on clinical examination.
I am amazed in my consulting room, at the many bright female graduates, who often work in the financial world and are clearly better at examining balance sheets than their breasts. I hope that the statement, "Doctor, I do not know what I am looking for", will have no relevance in the 1990s, and there will be no repetition of the heroic but horrific surgery that was recommended by some of my teachers, which resulted in physical and psychological mutilations to so many women. I do not deny that lives were saved, but at what cost?

Ms. Gordon: Will the hon. Gentleman give way?

Dr. Goodson-Wickes: I am working against the clock; I apologise for any discourtesy.
There is insufficient public recognition of the correlation between smoking and cancer of the cervix. The increased incidence of smoking by women is almost certainly the main factor behind cancer of the lung that is


now challenging cancer of the breast as the main malignant killer of women. Smoking will also increase the major cause of death, which is ischemic heart disease. My hon. Friend the Minister referred to the fact that it results in the the delivery of small babies.
It is illogical and had medicine to limit the examination of women to organs that are peculiar to them without at the same time checking their blood pressure and advising them on issues such as weight and smoking. I hope that my hon. Friend will develop the theme of primary health care for women, since they are such valuable members of the community.

Mrs. Currie: By leave of the House, I should like to respond to an excellent debate. I am conscious of the fact that some hon. Members have not had the opportunity to speak. We may need to have another debate. We heard splendid speeches, particularly from Lady Members, including my hon. Friends the Members for Plymouth, Drake (Miss Fookes), for Norfolk, South-West (Mrs. Shephard), for Billericay (Mrs. Gorman), for Torridge and Devon, West (Miss Nicholson), and from my hon. Friends the Members for Winchester (Mr. Browne) and for Wimbledon (Dr. Goodson-Wickes). I listened with interest to the speeches of other hon. Members. Some hon. Members have sat here for four hours waiting to speak. I apologise to any men including my hon. Friend the Member for Wimbledon, who felt left out. However, on 23 October we had a full day's debate on prevention when we concentrated on heart disease, which particularly affects men. Perhaps today, therefore, is the women's turn.
As to whether anybody is taking any notice of campaigns on health, I refer hon. Members to the food purchasing patterns, reported in the national food survey every quarter by the Ministry of Agriculture, Fisheries and Food. It shows that people are making strenuous efforts, by their purchasing patterns of food for consumption in the home, to eat much healthier food.
I am also grateful to those Lady Members who have had to leave but who were courteous enough to let me know. The hon. Member for Preston (Mrs. Wise) made quite the nicest speech that I have heard her make since she returned to the House. I am grateful to her for her kind remarks about our campaign on breast feeding. I suspect that female Members of Parliament on both sides of the House are much nicer and much more courteous to each other than their male counterparts. I venture to suggest—it is a remark of total prejudice—that if, nay when, there are more female Members of Parliament, behaviour will improve dramatically.
The hon. Member for Coventry, North-East (Mr. Hughes) asked a number of specific questions relating to Coventry. I hope that he will allow me to read what he has said and to write to him, particularly about the family practitioner committee. I am grateful to a number of hon. Members for referring to measles. We are very concerned about measles, as the disease has resulted in the death of six children this year. We have already made approaches to general practitioners. We shall have to consider whether those approaches have been successful and, if not, what else we can do.
A number of hon. Members, including my hon. Friend the Member for Torridge and Devon, West referred to the introduction of MMR—the measles, mumps and rubella

vaccine—in the autumn. That is a major step forward and we hope that it will be of considerable benefit. It will cost the Government rather more than £40,000 or £80,000. We are budgeting for several million pounds because we shall have to pay for the vaccine. However, we expect it to result in a considerable long-term saving. About 2 per cent. of women who are susceptible to the disease catch rubella every year. Between 300 and 400 women feel obliged every year to check whether their babies have been handicapped in any way. We know of 20 cases of congenital syndrome rubella every year, each one of which could have been prevented.
The hon. Member for Barking (Ms. Richardson) referred to a number of issues and talked about the scandal of the VDUs. Unless any hon. Member should think that I am referring to a sexually transmitted disease, I should explain that VDU stands for visual display unit. The hon. Lady and I know that, but my experience in this job suggests that not everybody understands precisely what it means. The hon. Lady and I are referring to people who may or may not be affected by working in circumstances in which they are obliged to be close to a VDU for long periods.
The Industrial Injuries Advisory Council published a report on non-ionising radiation in December 1987. During its investigations, the council considered the possibility of VDUs being a potential source of harmful radiation. It concluded that there was no evidence to suggest that the present terms of prescription for industrial injuries purposes should be extended to cover any potential effects of non-ionising radiation from VDUs. The Government accepted those recommendations. As I have suggested, I suspect that at least part of the problem may arise from the fact that women get far too little exercise. Perhaps we may encourage companies and employees to take that into account. That is the scientific evidence on VDUs as it stands at the moment.
A number of Labour Members referred to the social security system. I would point out that in this country the pension scheme in particular contains several features that are very favourable to women. For example, we retire five years earlier than men. Under the United Kingdom scheme the married woman has the right to obtain a pension of her own through her husband's contributions if she wishes. There is nothing similar in most European countries.
Hon. Members have spoken of poverty. The hon. Member for Preston said that the BMA had established that a healthy diet cost more. My nutrition unit tells me that there has been no such report from the BMA, although the report from the Maternity Alliance was referred to earlier. If the hon. Lady has futher information, we should be delighted to hear it. We do not know that the BMA or anyone else has established that a healthy diet costs more. I do not believe it. It costs nothing to throw away the frying pan or to replace one kind of fat with another and it is probably cheaper simply to eat less fat.
A number of hon. Members on both sides of the House called for a cross-departmental committee. I am reminded of that splendid series, "The Wheeltappers' and Shunters' Club," which used to appear on television. The programme often used to start, "We've got to get a committee together on this." In fact, there is already a committee—the ministerial group on women's issues, which is chaired by my hon. Friend the Minister of State, Home Office and which considers some of the issues that


have been raised. There is also the Women's National Commission, which is part of the Cabinet Office, which is ably chaired by my hon. Friend the Minister of State, Department of Education and Science. I have no doubt that that commission will take into account a number of points that have been made.
I see that my hon. Friend the Member for Plymouth, Drake is in her place. I do not know whether she has been reconstructed recently but she is looking absolutely splendid these days. It must be to do with her responding vigorously to everything that previous Ministers and I have said recently. I am very glad to see my hon. Friend, who has been a doughty fighter for women since she came to the House 18 years ago. I am extremely grateful to her for her remarks, and for encouraging women in her constituency to have smear tests.
My hon. Friend the Member for Plymouth, Drake mentioned breast amputation and women's concern about that. I am glad to be able to tell her that a recent study has shown that between 1980 and 1986 in 80 centres in this country the ratio of mastectomy to conservative surgery such as lumpectomy has shifted from around 50–50 to about 20–80. In other words, about 80 per cent. of surgery does not involve full amputation. However, conservative surgery is not suitable in all cases and clearly more work remains to be done on that.
My hon. Friend the Member for Plymouth, Drake and a number of other hon. Members referred to women doctors. I shall undertake to send a copy of the detailed press release sent out on Wednesday by my right hon. Friend the Minister for Health about the publication of Isobel Allen's report. The release is entitled "Women Doctors—Any Room at the Top?" Incidentally, a minute

that I received about smoking in DHSS offices was entitled "The Empire Strikes Back"; clearly someone in my Department has a sense of humour.
The detailed minute that has been issued shows both our concern that there should be more women doctors and our interest in what happens when they start on their career path. Action is already under way, or is being set in hand, on a number of the issues identified in Isobel Allen's excellent report. We recognise, for example, the demands for more part-time career posts and we shall discuss with representatives of the Health Services and the medical profession the possibility of increasing them. We shall also discuss with the Royal colleges and faculties, postgraduate deans and health authorities, ways of eliminating questioning by appointments boards that can be seen to be discriminatory. To assist that process we are arranging two seminars to promote consideration of Miss Allen's report by representatives of health authorities and the medical professions. I am conscious that I lay myself open to the criticism from the hon. Member for Barking that there tend to be a great number of seminars—but they work. The hon. Lady will remember that in the Labour party document on health that it published in preparation for the election, the only picture of a doctor was of a man.
My hon. Friend the Member for Winchester raised issues concerning his constituency, and he knows that we are concerned about them. My hon. Friend the Member for Norfolk, South-West, in an outstanding contribution, set out exactly how a good service for women should be run. That spills over into other forms of health care, where the needs and the interests of the consumer, male and female, really start to matter. That is the sort of service that we are trying to promote for women, children and men throughout the country.

It being half-past Two o'clock, the motion for the Adjournment of the House lapsed, without Question put.

Maternity Facilities (Moray)

Motion made, and Question proposed, That this House do now adjourn.—[Mr. Kenneth Carlisle.]

Mrs. Margaret Ewing: It is, perhaps, appropriate that at the end of an extensive debate that touched on so many issues affecting women's health, we should move on to specific issues affecting the well-being of the women in my constituency.
I wish to start with a few personal remarks. Yesterday I attended the funeral of Dr. Allan Matheson, who was a key figure in all our efforts in Moray not only to improve maternity services but to enhance all of Moray's medical facilities. Like me, the community of Keith has been devastated by his tragic and untimely death at the age of 39. All of us remember his unstinting work in his community—his selfless, sincere and abiding concern for all the patients in the local practice. His commitment to those with special needs was reflected in his work for the Sunshine playgroup, his involvement with the Keith patients participation group, the local parent teachers' association and the Keith caring service. Keith has lost a great friend. As was said at his funeral yesterday, it is a fitting memorial to his life and his work that his activities helped to persuade Grampian health board to retain a maternity unit in the Turner memorial hospital. I am sure that the Minister, who met Allan Matheson during that campaign, will join me in recording our deepest sympathy to his wife Hazel and his children Kirsty, Rhona and Duncan.
To return to the issue of the debate, I understand that the Scottish Office has received a full submission from the Grampian health board recommending that five general practitioner maternity units should be closed. I note the Minister indicating dissent, but must tell him that I was given that advice last week when I spoke to a representative of the board. I apologise if the Minister has not yet received it, but it is certainly on its way. The submission is to close the five GP maternity units in the area, with no further consideration being given to the possible establishment of a specialist obstetric and gynaecological unit in Elgin.
My first key questions, therefore, are can the Minister say when the Scottish Office will give a response, how will the announcement be made, and what provision will be made in the coming weeks for representatives of the Scottish Office to meet local interested groups representing both the medical profession and the public? Such meetings would be desirable before any final decision is reached.
As the Minister well knows, the Grampian health board's proposals met with universal antagonism throughout the region. While this debate relates specifically to Moray, I wish to emphasise the general principles underpinning that reaction. Together with the right hon. Member for Kincardine and Deeside (Mr. Buchanan-Smith) and the hon. Member for Gordon (Mr. Bruce), I have argued that women in rural areas have the right to give birth in local hospitals. All three of us, irrespective of party politics, feel most strongly that choice and safety are being ignored, and we resent the centralising philosophy that denies our mothers the right to have access to local facilities that, over the years, have been marked by the highest standards of care and practice.
Our mothers are to be asked to undertake hazardous and lengthy journeys. They will be removed from the familiar surroundings of their local units and distanced from family and friends at a time when they wish to be in their local communities. All three of us believe that that is against the interests of our constituents and communities. We are certain that no good reason has been put forward for doing that.
There are two key issues in Moray. First, Leanchoil hospital in Forres is to lose its maternity unit and all mothers are to be transferred to Raigmore hospital in Inverness, which is in a different health board area. It appears that complex negotiations—though not public negotiations—have taken place between Grampian and Highland health boards, and the former will pay the latter for such obstetric facilities. Will the Minister give me some guidance? First, what costing of that deal has Grampian health board given? Secondly, are the obstetricians based in Inverness prepared to accept full responsibility for all aspects of pregnancy, labour, delivery, neonatal and paediatric care that were previously dealt with by general practitioners in Forres?
Thirdly, is the Minister satisfied that Raigmore hospital will be able to cope with increased numbers, including the provision of lying-in facilities for new mothers? Fourthly, has any costing been made or will a costing be made of accepting the suggestion from Leanchoil general practitioners that the current 12-bed unit be reduced to six beds, with the other beds being given to orthopaedic facilities? Fifthly, has any account been taken of the importance attached to Leanchoil by young RAF families based at RAF Kinloss? Sixthly, what safety net is to be left for emergencies for Forres mothers who, for whatever reason, cannot travel to Raigmore?
Dr. Russell Lees, a consultant obstetrician and gynaecologist at Raigmore, commented:
We, the Consultants in the Department of Obstetrics in Raigmore view with anxiety the prospect of an increased demand for home confinements which could conceivably arise as a result of the closure of the maternity unit at Leanchoil and it is for that reason that we would support the retention of a six bedded unit at Forres for uncomplicated deliveries with the additional benefit of "lying in" facilities for those mothers who deliver their babies in Raigmore but whose medical condition is such that they can be looked after in the early days … in a hospital nearer home.
That issue directly affects Forres and the western side of my constituency.
The next main issue for Moray is the need to establish a full-scale specialist obstetric unit in Elgin, which is regarded as the centre of the district. Perhaps the fate of the Turner memorial and Leanchoil hospitals would not have met such antagonism had Grampian health board offered us a locally based specialist facility. However, the long-held hope that Elgin would have such a unit has apparently been ditched for good by the board. Instead, Aberdeen and Inverness are to be the central points for such services. The suggestion is that all women east of the Spey will be asked to attend Aberdeen maternity hospital and that all women west of the Spey will be asked to attend Raigmore and Inverness hospitals.
On my latter point relating to the geographical area west of the river Spey, I again refer to comments made by Russell Lees, the consultant obstetrician at Raigrnore hospital in Inverness. He stated:
I feel I should add that the Consultants in the Department of Obstetrics at Raigmore view with some concern the prospect of transfer of maternity care patients in


the Elgin area from Grampian Health Board to Highland Health Board, and we are uniformly of the opinion that without additional facilities in terms of beds and staff at all levels we could not provide a similar quality of care to that which is already provided by this Department for mothers from the Highland Region.
Dr. Lees said that against the background of an increase in the bed complement at Raigmore from 56 to 72. It is not enough to say that facilities at Raigmore have already been increased.
In whatever direction the mums in my constituency are pointed, they face lengthy and hazardous journeys along the A96—a road that is notorious for delays and accidents at all times of the year. Obviously, that road is most dangerous in winter. Recently, it was branded by the Inverness chamber of commerce as a goat track, and by the Royal Automobile Club as a death trap. In conjunction with all the district councils near that road, Highland and Grampian regional councils are mounting a major campaign to improve the A96. It seems unlikely that that will be within the immediate future, although piecemeal opportunities have been given for slight improvements on the road.
We must think of women who are in distress—perhaps already aware that the life of their baby is at risk—being driven over a road that they know is in poor condition. Often, they are already in labour, strapped to a drip, and in severe pain. No one could harden his or her heart to the psychological and physical stress that such an experience must create. We must remember that such women may not have their husbands with them, and may have left behind young children.
There is, of course, the flying squad. On page 10 of unit II's strategic plan for maternity and neonatal services in Grampian, it says:
Once the Flying Squad call is received it takes an average 30 minutes to assemble medical staff, equipment and taxi and if the call is to Elgin, for example, then a further one hour 45 minutes transport time ensues to reach the destination. This delay may be crucial to patient management. Often, because of the time factor involved, the patient is sent by ambulance to Aberdeen and may deliver en route.
So now it is being suggested that a helicopter could form part of the normal service to mums in my area. The same report says that it should be part of the normal service to have a helicopter as a standby to transport mums in labour from my constituency.
I have never travelled by helicopter, but many who have—including my husband who is a member of a mountain rescue team—tell me that it is without doubt the most unpleasant and uncomfortable form of transport imaginable. The idea that women in labour and in stress should be asked to regard a helicopter as a mainstay is unpalatable.
We should consider Grampian health board's reasons for opposing the establishment of a specialist unit such as we want in Moray. The board says:
There is no definitive guidance on the optimum population to be served by a full specialist obstetric facility".
It seems that, in the absence of definitive guidance, the board is prepared to reach its own definition. By using the Gavin Shaw report, which recommends a minimum of three consultant obstetricians, Grampian health board concludes that 1,100 births per year do not justify the establishment of such a unit.
My argument, like that of my fellow campaigners in Moray, challenges that assertion. I shall use the facts and fugures provided by MUM—theMaternity Unit for Moray campaign—which says:
In a centre of population such as Moray, with 26,361 females aged 16–64 and 6,880 females aged 65–89, is it appropriate to provide obstetric and gynaecological services for the majority of these women, either 68 miles away in Aberdeen or 37 miles away in Inverness? Miss Hines, the Director of Midwifery Services in Grampian stated on 11 February 1988 at the public meeting in Elgin, that she could not justify or defend the decision of Grampian Health Board to continue to send mothers such distances for obstetric care.
On page 2 of its strategic plan, unit II says:
The total number of births in Grampian will fall to approximately 6,500 by 1991: of these 1,300 babies will be born to women living in Moray. The numbers for 1996 are approximately 6,300 and 1,400 respectively.
In other words, we are anticipating an increased birth rate in the Moray district. We know that obstetric units which cater for smaller numbers have been established elsewhere in Scotland and I believe that, south of Perth, the norm for such facilities is a travelling distance of something less than 30 miles.
Grampian health board also believes that the number of cases that it predicts would not attract consultants of the quality that it desires. That must be one of the most spurious arguments that has been advanced. Elgin has never experienced any difficulty attracting consultants of the highest calibre on other specialties, and nobody but Grampian health board anticipates any difficulty in attracting obstetricians.
If population were used as the sole criterion for the establishment of specialist centres in rural communities, we could fully expect all specialist centres in Scotland to be based in cities. It is therefore an argument to which we cannot give any credence and I hope that the Minister, who also represents a rural constituency, will reject it.
I trust that the Minister will give us hope in Moray that the maternity services that we already have and appreciate will not be taken from us. Our GP units are of the highest standard and the public has shown its confidence in them by the demand for their retention. The files that I have on the Bench beside me represent the strength of feeling from my constituency. Those files contain letters of support and argument, not just from the GPs or from the medical practitioners within my constituency, but from hundreds of ordinary men and women who are deeply concerned about their community. This argument is not about statistics and, according to the Grampian health board, nor is it completely about costs. The argument is about life. It is about safety and proper medical care. In Moray we are refusing to be regarded as second-class citizens.

The Parliamentary Under-Secretary of State for Scotland (Mr. Michael Forsyth): I was sad indeed to hear the news about Dr. Allan Matheson. I well recall the hon. Lady bringing a delegation to see me about the Keith maternity unit. The clear commitment that Dr. Matheson had to the community was evident from our discussions. I join the hon. Lady in expressing my condolences to his wife and family on such a tragic loss.
The hon. Lady expressed some surprise when I said from a sedentary position that I had not received the final submission from the Grampian health board. I received in April some preliminary material regarding its proposals for closure. Additional infomation was forwarded to my


Department on 2 June, and the remainder is expected within the next fortnight. Therefore, I have to dissappoint the hon. Lady because I am unable to say very much today—in fact nothing—about the substance of the board's case or to reply to her arguments. However, I have had a large number of representations on this matter from a wide variety of opinions and from every section of the community in Moray. In fact, a few weeks ago I had a lengthy discussion with the chairman of the health council, Mrs. Rona Hossack. I have given an undertaking to the officers of the health council that before coming to any conclusions on the matter I will meet them to discuss the arguments. I hope that the hon. Lady will accept that as going some way towards meeting her request that I should take account of local opinion on this matter before reaching a conclusion.
It clearly would not be appropriate for the Scottish Office to embark upon a whole new consultation process, because these matters are for the board. I am sure that the hon. Lady will forgive me if I make one rather pertinent observation. In this debate the hon. Lady is asking me and my right hon. and learned Friend to overturn the decisions of the Grampian health board and direct it to do something else. It was only a few weeks ago that she was strongly chiding me and criticising me in public for directing the health board on competitive tendering. She was then arguing that it was no part of the Secretary of State's duty to undermine the local autonomy of health boards. Having said that, the breadth of feeling on this matter is clear.

Mrs. Margaret Ewing: I am grateful to the Minister for allowing me to intervene. I am conscious of the time constraint. Some of his latter comments have been mischievious but I shall not respond to them. On the issue of consultation within the community, and over and above meeting the representatives of the full health council, will it be possible for representations to be received from general practitioners in Forres, and will there be discussions with the obstetricians in Raigmore, which is within the Highlands health board.

Mr. Forsyth: I shall consider all the arguments, but it is the job of the health board to carry out the consultation process and reach conclusions, and it requires the consent of the Secretary of State. The hon. Lady is asking my right hon. and learned Friend to overturn its conclusions following its consultation, and it would not be appropriate for my right hon. and learned Friend to be involved in consultation. Having received strong representations from Mrs. Hossack, I agreed to meet officers of the health council before reaching any conclusion. I have agreed to meet a delegation that my right hon. Friend the Member for Kincardine and Deeside (Mr. Buchanan-Smith) is bringing to deal with the issue of Torphins prior to reaching any conclusions.
I have received representations from the Maternity Unit for Moray campaign and I shall examine carefully the specialist unit proposal. I have also received representations from regional and district councillors and others through the political network from the Moray Conservatives. I accept that it is an issue of concern to every sector of the community.
There was the hint in the hon. Lady's speech that resources have had a part to play—she referred to the overall level of funding available to the Grampian health

board—but I do not believe that they have. Conclusions should have been reached on the basis of what will provide the best quality of patient care for the people of Moray. The Grampian health board has seen a substantial increase in the resources granted to it since the Government came to power. Since 1979, the amount of money available to the health board to meet running costs has increased by one third over and above inflation. The increase in capital resources that has been made available to the board to fund new developments and new hospital projects has been spectacular. That level of funding has almost doubled in real terms, there having been an increase of 96 per cent. since 1979.
I know that the hon. Lady will be aware of the difference between the resources that are available to the health boards now and those which were available when the Labour Government were in office, whom she and her party were keen to support.
When that Government were in office we saw a 28 per cent. cut in the capital expenditure made available to health boards in Scotland. These figures are sometimes dismissed as mere statistics or just numbers, but they are not. The increased funding that we have provided for Grampian is seen in new developments. Phase 1 of the new royal Cornhill hospital will begin construction in October and will improve the services that are available to the mentally ill. When I visited Foresterhill I announced that £3 million would be made available for the new blood transfusion centre that will open in 1991. More central to the hon. Lady's constituency interest is the redevelopment at Dr. Gray's hospital to replace the Maryhill maternity unit, which will cost more than £1 million. I recently announced the extension of cardiac surgery in Grampian that will result in a capital investment of about £1·2 million over a period. As we are now taking centrally the funding of cardiac surgery operations there, the result will he a windfall running cost benefit to the health board of about £250,000.
The board has benefited from some substantial extra money. I urge the hon. Lady to recognise that and to recognise also that any decisions should be based on what represents value for money. The review of maternity services is designed to ensure that the needs of the people are met as well as to ensure efficiency.
Lest these discussions seem to be limited to Grampian, let me say that other health boards are having to consider these matters. Lothian has had to consider the problem of the underutilisation of maternity beds. Clearly, it is in no one's interest to have beds which are staffed but which are not needed, because that constitutes a waste of resources. Today my right hon. and learned Friend has approved a restructuring of obstetric services in Lothian which will involve the closure of the Elsie Inglis maternity hospital in Edinburgh. He was prepared to give consent on the basis that for years there had been an oversupply and underuse of obstetric beds and that the position would be made worse because of the opening of new obstetric services in the Borders. He also took account of the facts that the proposals have the support of Lothian health board's professional advisory committees and that the savings will be fully available to the board to promote development and improvement in the services in other areas.
The hon. Lady asked about the A96. Fortunately, roads are not within my area of responsibility, but the importance of the A96 is fully recognised. Works worth some £6 million are under construction; £44 million worth


of work is planned and a major feasibility study is under way. Progress on future schemes will be determined by the satisfactory completion of statutory procedures, the availability of finance and the priority of particular schemes within the context of competing claims from the entire trunk road network in Scotland.
The hon. Lady will forgive me for pointing out that in Scotland we enjoy a Health Service that is funded to the extent of rather more than a quarter more per head t n the Health Service in England. Our roads programme is also considerably better funded. Were it not for the fact that I would be called to order, I would be intrigued to hear from her how she imagines that continued support would be available if we were to follow the prescriptions of her party.
I shall listen carefully to all the arguments and study with the greatest possible care the papers, submissions and

letters we receive in the Department. I am happy to hear from the hon. Lady of any additional arguments, other than those which she put in the debate and in correspondence with me. I will make arrangements to meet the officers of the health council. The personal remark which she addressed to me about my constituency interest and recognition of the problems of rural areas strikes home. I need no convincing because when my wife was expecting our latest child, the central thought in her mind was the 25 miles which were involved from Aberfoyle to Stirling, so I am aware of the anxieties and feelings. I shall ensure that the arguments are considered carefully before we reach a conclusion.
The hon. Lady asked when we would reach a conclusion. In the time-honoured phrase which trips off the tongue so easily after a mere year at this job, we would expect to reach a conclusion as soon as possible and shortly.

Question put and areed to.

Adjourned accordingly at two minutes to Three o'clock.